Provider Demographics
NPI:1114388311
Name:ANDREW TROSIEN DDS MS INC
Entity type:Organization
Organization Name:ANDREW TROSIEN DDS MS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TROSIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-833-1240
Mailing Address - Street 1:2850 N TRACY BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-7767
Mailing Address - Country:US
Mailing Address - Phone:209-833-1240
Mailing Address - Fax:209-833-0699
Practice Address - Street 1:2850 N TRACY BLVD
Practice Address - Street 2:STE 300
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-7767
Practice Address - Country:US
Practice Address - Phone:209-833-1240
Practice Address - Fax:209-833-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty