Healthcare Provider Details

I. General information

NPI: 1821106436
Provider Name (Legal Business Name): RICARDO HUERTA-ANDRADE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7181 STATE ROUTE 96
VICTOR NY
14564-8989
US

IV. Provider business mailing address

3349 MONROE AVE STE 334
ROCHESTER NY
14618-5513
US

V. Phone/Fax

Practice location:
  • Phone: 585-924-4050
  • Fax: 585-924-4905
Mailing address:
  • Phone: 585-820-1250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number052271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: