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Provider Information for 1053472365



CLARA NANCY ANDIRIOUS D.D.S.

Gender: FEMALE

Individual NPI: 1053472365

Calendar   Last Updated:  2016-01-29
  Certification Date: 

Details

Name Value
NPI 1053472365
Enumeration Date 2006-12-12
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 6472 CAMDEN AVE. SUITE 100
SAN JOSE, CA 95120
United States

Phone: 408-997-9027 | Fax: 408-997-7852
View Map External Link
Primary Practice Address 6472 CAMDEN AVE. SUITE 100
SAN JOSE, CA 95120
United States

Phone: 408-997-9027 | Fax: 408-997-7852
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID CA G93394-01
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 51545
No 1223G0001X - Dentist General Practice CA 51545