Healthcare Provider Details

I. General information

NPI: 1639544885
Provider Name (Legal Business Name): LUIS C ANDREWS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2015
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 20TH ST
MERCED CA
95340-3715
US

IV. Provider business mailing address

505 W 20TH ST
MERCED CA
95340-3715
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-2980
  • Fax: 209-725-2984
Mailing address:
  • Phone: 209-725-2980
  • Fax: 209-725-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number49269
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49269
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number49269
License Number StateCA

VIII. Authorized Official

Name: DR. LUIS CARLOS ANDREWS
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 209-725-2980