Provider Demographics
NPI:1255633392
Name:SOSA, ANDREA ALEJANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ALEJANDRA
Last Name:SOSA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 108 PMB 120
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1643
Mailing Address - Country:US
Mailing Address - Phone:916-681-8835
Mailing Address - Fax:
Practice Address - Street 1:8835 SHELDON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5046
Practice Address - Country:US
Practice Address - Phone:916-681-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice