Provider Demographics
NPI:1295739126
Name:DENTINO, ANDREW N (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:N
Last Name:DENTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9183
Mailing Address - Country:US
Mailing Address - Phone:956-362-3575
Mailing Address - Fax:956-362-3584
Practice Address - Street 1:5423 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9183
Practice Address - Country:US
Practice Address - Phone:956-362-3575
Practice Address - Fax:956-362-3584
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29405207RG0300X
MS19565207RG0300X
TXL4331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477283-05Medicaid
TXH08HM98801OtherBCBS