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General NPI Number Information
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NPI Number | 1356952071
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Entity Type | Individual
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Provider Name | ANDREA CHICCHON- CANTON DMD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 2363 W MARCH LN
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City | STOCKTON
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State | CA
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Zip | 95207-5239
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Country | US
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Telephone | 209-952-3951
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Fax |
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Provider Business Mailing Address
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Address Line | 8623 CAREY CT
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City | STOCKTON
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State | CA
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Zip | 95212-1404
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Country | US
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Telephone | 209-938-7557
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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 | 105083
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License Number State | CA
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