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General NPI Number Information
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NPI Number | 1346759487
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Entity Type | Organization
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Legal Business Name | ANDES DENTAL PLLC
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1157 E 42ND ST STE A
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City | ODESSA
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State | TX
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Zip | 79762-7723
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Country | US
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Telephone | 432-242-6666
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Fax | 832-379-5175
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Provider Business Mailing Address
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Address Line | 1157 E 42ND ST STE A
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City | ODESSA
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State | TX
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Zip | 79762-7723
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Country | US
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Telephone | 432-242-6666
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Fax | 832-379-5175
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Authorized Official
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Title or Position | MEMBER
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Name | KEERTHI MIRYALA
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Credential | DMD
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Telephone | 832-762-1914
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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 |
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License Number State |
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