Provider Demographics
NPI:1831731009
Name:ANDREW DACUNHA, DMD, PA
Entity type:Organization
Organization Name:ANDREW DACUNHA, DMD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DACUNHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-417-7400
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty