MEDICARE: DR. NORMA L ANDRONIC DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	53897	CA
2	122300000X	Dentist	53897	CA

General Provider Information

NPI Number	:	1104029073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMA L ANDRONIC DDS

Provider Business Mailing Address
First Line	:	2744 CAPE DR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-5764
Country	:	US
Telephone Number	:	619-729-9834
Fax Number	:

Provider Business Practice Location Address
First Line	:	6445 PATS RANCH RD STE G
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	91752-4439
Country	:	US
Telephone Number	:	951-808-5881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/24/2024

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