Provider Demographics
NPI:1992321087
Name:CARDOSO, ANDRE (DMD)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:CARDOSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7546
Mailing Address - Country:US
Mailing Address - Phone:801-471-3690
Mailing Address - Fax:
Practice Address - Street 1:837 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1315
Practice Address - Country:US
Practice Address - Phone:406-665-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT213771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice