Provider Demographics
NPI:1427943851
Name:PALACIOS, ANDRES EDUARDO (DMD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:EDUARDO
Last Name:PALACIOS
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 1:1476 VARSITY DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-7846
Mailing Address - Country:US
Mailing Address - Phone:956-624-3767
Mailing Address - Fax:
Practice Address - Street 1:432 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5613
Practice Address - Country:US
Practice Address - Phone:928-636-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist