Provider Demographics
NPI:1023709805
Name:SEDRA, ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SEDRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7781 GOLD BUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5858
Mailing Address - Country:US
Mailing Address - Phone:909-647-5158
Mailing Address - Fax:
Practice Address - Street 1:17003 BEAR VALLEY RD STE D
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1420
Practice Address - Country:US
Practice Address - Phone:760-244-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA110694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program