Provider Demographics
NPI:1073248969
Name:LACERDA, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LACERDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LACERDA
Other - Last Name:DE ARAUJO LIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2911 ZURICH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2883
Mailing Address - Country:US
Mailing Address - Phone:860-416-7497
Mailing Address - Fax:
Practice Address - Street 1:20711 WILDERNESS OAK STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2641
Practice Address - Country:US
Practice Address - Phone:210-787-1200
Practice Address - Fax:210-497-6077
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX410371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry