MEDICARE: ANDY P. DUONG DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1922770817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDY P. DUONG DDS PC

Provider Business Mailing Address
First Line	:	4440 SAN PABLO DAM RD STE C
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3052
Country	:	US
Telephone Number	:	510-223-4311
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 SAN PABLO DAM RD STE C
Second Line	:
City	:	EL SOBRANTE
State	:	CA
Zip	:	94803-3052
Country	:	US
Telephone Number	:	510-223-4311
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	MR. ANDY DUONG
Credential	:	DDS
Telephone Number	:	415-812-3642

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	09/29/2021

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