Provider Demographics
NPI:1861129884
Name:ZUFALL, ANDREW BLAKE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BLAKE
Last Name:ZUFALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0200
Mailing Address - Country:US
Mailing Address - Phone:530-246-1188
Mailing Address - Fax:
Practice Address - Street 1:2950 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0200
Practice Address - Country:US
Practice Address - Phone:530-246-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist