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General NPI Number Information
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NPI Number | 1437776812
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Entity Type | Organization
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Legal Business Name | ANDY L. TIEU DDS, INC.
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 6790 TOP GUN ST SUITE 5
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-831-0707
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Fax | 858-831-0770
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Provider Business Mailing Address
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Address Line | 6790 TOP GUN ST SUITE 5
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 858-831-0707
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Fax | 858-831-0770
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Authorized Official
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Title or Position | DENTIST
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Name | ANDY L TIEU
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Credential | DDS
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Telephone | 858-831-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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