Provider Demographics
NPI:1720615560
Name:CABRERA, ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CABRERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78640 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2048
Mailing Address - Country:US
Mailing Address - Phone:916-208-1522
Mailing Address - Fax:
Practice Address - Street 1:78640 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2048
Practice Address - Country:US
Practice Address - Phone:760-564-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1067691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice