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General NPI Number Information
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NPI Number | 1003641978
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Entity Type | Organization
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Legal Business Name | ANDONIAN DENTAL CORP
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Dates
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Enumeration Date | 09/03/2024
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 18430 BROOKHURST ST STE 104
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6726
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Country | US
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Telephone | 714-963-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 17312 DREY LN
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-5616
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Country | US
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Telephone | 614-256-6636
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER WILLIAM ANDONIAN
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Credential | DDS
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Telephone | 614-256-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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