Healthcare Provider Details

I. General information

NPI: 1952002099
Provider Name (Legal Business Name): CHEZIEL ANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D DENTAL BATTALION 3D MLG UNIT 38450
FPO AP
96373
US

IV. Provider business mailing address

101 KUWAE APT 401
CHATAN OKINAWA
9040103
JP

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number34963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: