Provider Demographics
NPI:1902290554
Name:FOLAYAN, ANDREA (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FOLAYAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15130 MOONLIGHT MIST DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3963
Mailing Address - Country:US
Mailing Address - Phone:209-484-9877
Mailing Address - Fax:
Practice Address - Street 1:FOUR LION DENTAL BOUTIQUE
Practice Address - Street 2:16430 WEST LAKE HOUSTON #700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044
Practice Address - Country:US
Practice Address - Phone:281-318-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-21
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice