MEDICARE: ANDREW N DENTINO MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	29405	OK
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	19565	MS
3	207R00000X	Internal Medicine Physician	L4331	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	H08HM98801	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1295739126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW N DENTINO MD

Provider Business Mailing Address
First Line	:	5423 S MCCOLL RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9183
Country	:	US
Telephone Number	:	956-362-3575
Fax Number	:	956-362-3584

Provider Business Practice Location Address
First Line	:	5423 S MCCOLL RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9183
Country	:	US
Telephone Number	:	956-362-3575
Fax Number	:	956-362-3584

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/30/2021

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