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General NPI Number Information
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NPI Number | 1023312105
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Entity Type | Organization
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Legal Business Name | ANDRE & JUDSON DENTAL CORPORATION
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 1436 CEDARWOOD LN STE C
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City | PLEASANTON
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State | CA
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Zip | 94566-6150
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Country | US
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Telephone | 925-462-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 1436 CEDARWOOD LN STE C
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City | PLEASANTON
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State | CA
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Zip | 94566-6150
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Country | US
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Telephone | 925-462-1990
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Fax |
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Authorized Official
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Title or Position | DENTIST/CHAIRMAN OF THE BOARD
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Name | DR. KERRY ELIZABETH ANDRE
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Credential | D.D.S.
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Telephone | 925-462-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43698
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43697
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License Number State | CA
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