Basic Information
| Provider Information | |||||||||
| NPI: | 1932206802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDRADE | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3336 BRADSHAW RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958272615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163682500 | ||||||||
| FaxNumber: | 9163682504 | ||||||||
| Practice Location | |||||||||
| Address1: | 2465 IRON POINT RD | ||||||||
| Address2: | STE. 120 | ||||||||
| City: | FOLSOM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956308710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169849600 | ||||||||
| FaxNumber: | 9169849076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 05/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 53964 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.