Provider Demographics
NPI:1831865765
Name:TADROS, ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:TADROS
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 1:1920 BATSON AVE APT 242
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-3425
Mailing Address - Country:US
Mailing Address - Phone:626-506-1106
Mailing Address - Fax:
Practice Address - Street 1:2216 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2944
Practice Address - Country:US
Practice Address - Phone:909-392-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist