Healthcare Provider Details

I. General information

NPI: 1912155276
Provider Name (Legal Business Name): ANDREW SALVADOR SUBIDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 MAGNOLIA AVE
LARKSPUR CA
94939-2035
US

IV. Provider business mailing address

428 MAGNOLIA AVE
LARKSPUR CA
94939-2035
US

V. Phone/Fax

Practice location:
  • Phone: 415-924-7900
  • Fax: 415-924-7901
Mailing address:
  • Phone: 415-924-7900
  • Fax: 415-924-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number1955
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number57468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: