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DR. ANTONIO FANDINO AGRA DMD
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1033277215
Individual Registrant:DR. ANTONIO FANDINO AGRA DMD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
17613 PIONEER BLVD ARTESIA, CA 90701 US
Tel: 562-809-8482 Fax: 562-402-4012
Tel: 562-809-8482 Fax: 562-402-4012
Contact information for business:
17613 PIONEER BLVD ARTESIA, CA 90701 US
Tel: 562-809-8482 Fax: 562-402-4012
Tel: 562-809-8482 Fax: 562-402-4012
Registration Information:
NPI: 1033277215
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | CA | 25664 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| MEDICAL | 501908 | CA | 01 |
