Basic Information
Provider Information
NPI: 1912155276
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SUBIDO
FirstName: ANDREW
MiddleName: SALVADOR
NamePrefix: MR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 505 W INDIANAPOLIS AVE
Address2:  
City: CLOVIS
State: CA
PostalCode: 936124963
CountryCode: US
TelephoneNumber: 5593460250
FaxNumber:  
Practice Location
Address1: 401 TRINITY AVE
Address2:  
City: CHOWCHILLA
State: CA
PostalCode: 936102851
CountryCode: US
TelephoneNumber: 5596651400
FaxNumber: 5596755224
Other Information
ProviderEnumerationDate: 08/28/2008
LastUpdateDate: 01/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X57468CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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