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General NPI Number Information
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NPI Number | 1003590985
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Entity Type | Individual
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Provider Name | JHON ANDRAOUS
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 9682 US HIGHWAY 19
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City | PORT RICHEY
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State | FL
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Zip | 34668-4642
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Country | US
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Telephone | 727-842-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 SHANNON CIR
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City | PALM HARBOR
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State | FL
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Zip | 34684-1877
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Country | US
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Telephone | 727-303-2493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28339
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License Number State | FL
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