Provider Demographics
NPI:1427255736
Name:DUONG, ANDY (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:DUONG
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 1:4440 SAN PABLO DAM RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-3052
Mailing Address - Country:US
Mailing Address - Phone:510-223-4311
Mailing Address - Fax:510-223-6262
Practice Address - Street 1:4440 SAN PABLO DAM RD
Practice Address - Street 2:SUITE C
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-3052
Practice Address - Country:US
Practice Address - Phone:510-223-4311
Practice Address - Fax:510-223-6262
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice