Provider Demographics
NPI:1780272682
Name:ANDINA DENTAL STUDIO INC
Entity type:Organization
Organization Name:ANDINA DENTAL STUDIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:HURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-588-3280
Mailing Address - Street 1:4100 DAWNBROOK DR STE 4
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3932
Mailing Address - Country:US
Mailing Address - Phone:302-543-5987
Mailing Address - Fax:302-510-4171
Practice Address - Street 1:4100 DAWNBROOK DR STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3932
Practice Address - Country:US
Practice Address - Phone:302-543-5987
Practice Address - Fax:302-510-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental