Healthcare Provider Details

I. General information

NPI: 1811994189
Provider Name (Legal Business Name): ANDREW ANTHONY VORONO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S CEDAR ST STE C
TACOMA WA
98405-2315
US

IV. Provider business mailing address

1950 S CEDAR ST STE C
TACOMA WA
98405-2315
US

V. Phone/Fax

Practice location:
  • Phone: 253-383-1471
  • Fax: 253-627-3753
Mailing address:
  • Phone: 253-383-1471
  • Fax: 253-627-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7577
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number26557
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18499
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: