Provider Demographics
NPI:1265704936
Name:ANDRE, KERRY ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ELIZABETH
Last Name:ANDRE
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 1:1436 CEDARWOOD LN STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6124
Mailing Address - Country:US
Mailing Address - Phone:925-462-1990
Mailing Address - Fax:925-462-7804
Practice Address - Street 1:1436 CEDARWOOD LN STE C
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6124
Practice Address - Country:US
Practice Address - Phone:925-462-1990
Practice Address - Fax:925-462-7804
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice