Individual
DR. ANTONIO FANDINO AGRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
17613 PIONEER BLVD, ARTESIA, CA 90701
(562) 809-8482
(562) 402-4012
Mailing address
17613 PIONEER BLVD, ARTESIA, CA 90701
(562) 809-8482
(562) 402-4012
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25664
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
501908
MEDICAL
CA
Enumeration date
12/04/2006
Last updated
07/08/2007
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