Provider Demographics
NPI:1801175054
Name:TOTH, ANDREA SALAZAR (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SALAZAR
Last Name:TOTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:PATRICIA
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:937 52ND ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6003
Mailing Address - Country:US
Mailing Address - Phone:616-531-1550
Mailing Address - Fax:616-531-0037
Practice Address - Street 1:937 52ND ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6003
Practice Address - Country:US
Practice Address - Phone:616-531-1550
Practice Address - Fax:616-531-0037
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010205291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice