Provider Demographics
NPI:1336571082
Name:DACUNHA, ANDREW ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALLEN
Last Name:DACUNHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 DOCTORS VILLAGE DR STE 303
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2406
Mailing Address - Country:US
Mailing Address - Phone:904-417-7400
Mailing Address - Fax:904-602-9995
Practice Address - Street 1:71 DOCTORS VILLAGE DR STE 303
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-2406
Practice Address - Country:US
Practice Address - Phone:904-417-7400
Practice Address - Fax:904-602-9995
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 203331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice