Provider Demographics
NPI:1225414402
Name:GUERRA ANDRADE, ERNESTO LEOPOLDO (DDS)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:LEOPOLDO
Last Name:GUERRA ANDRADE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 BOWEN DANIEL DR UNIT 802
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-1474
Mailing Address - Country:US
Mailing Address - Phone:787-613-5586
Mailing Address - Fax:
Practice Address - Street 1:14442 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2612
Practice Address - Country:US
Practice Address - Phone:813-866-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist