Individual
DR. ANDREW VANSICKLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1042 PACIFIC ST, STE B, SAN LUIS OBISPO, CA 93401
(805) 543-6963
(805) 543-8656
Mailing address
1042 PACIFIC ST, STE B, SAN LUIS OBISPO, CA 93401
(805) 543-6963
(805) 543-8656
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
61717
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/20/2011
Last updated
03/17/2016
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