MEDICARE: DR. ANDRES CONDE 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	122300000X	Dentist	107547	CA

General Provider Information

NPI Number	:	1619609872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRES CONDE DDS

Provider Business Mailing Address
First Line	:	1508 BARTON RD # 230
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-1410
Country	:	US
Telephone Number	:	619-732-6633
Fax Number	:

Provider Business Practice Location Address
First Line	:	44853 PORTOLA AVE STE B
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3703
Country	:	US
Telephone Number	:	619-732-6633
Fax Number	:

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

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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