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General NPI Number Information
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NPI Number | 1972041150
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Entity Type | Individual
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Provider Name | ANDREW CARRANCO DMD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 615 BARSTOW AVE
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City | CLOVIS
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State | CA
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Zip | 93612-2230
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Country | US
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Telephone | 559-314-2408
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Fax |
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Provider Business Mailing Address
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Address Line | 2497 HERNDON AVE STE 104
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City | CLOVIS
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State | CA
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Zip | 93611-8977
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Country | US
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Telephone |
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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 | 30025261
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 30025261
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 108198
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License Number State | CA
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