Provider Demographics
NPI:1184972978
Name:TADROS, ANDREW MINA (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MINA
Last Name:TADROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 15TH ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-6550
Mailing Address - Country:US
Mailing Address - Phone:714-330-3665
Mailing Address - Fax:
Practice Address - Street 1:11525 JUPITER RD STE 103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2579
Practice Address - Country:US
Practice Address - Phone:469-917-7444
Practice Address - Fax:469-917-7446
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice