Provider Demographics
NPI:1144587601
Name:ANDREWS, PAMELA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARIE
Last Name:ANDREWS
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 1:132 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4601
Mailing Address - Country:US
Mailing Address - Phone:209-239-5996
Mailing Address - Fax:209-824-8116
Practice Address - Street 1:132 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4601
Practice Address - Country:US
Practice Address - Phone:209-239-5996
Practice Address - Fax:209-824-8116
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice