Provider Demographics
NPI:1265959605
Name:ANDREWS, LACEY C (DDS)
Entity type:Individual
Prefix:DR
First Name:LACEY
Middle Name:C
Last Name:ANDREWS
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 1:172 SILVER EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-1012
Mailing Address - Country:US
Mailing Address - Phone:707-365-0542
Mailing Address - Fax:
Practice Address - Street 1:3694 HILBORN RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7994
Practice Address - Country:US
Practice Address - Phone:707-422-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1018041223G0001X, 1223P0221X
MADN18580801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice