Andrew W Spath, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

56009 Issued in CA

Practice address

2121 E Coast Hwy Ste 290
Corona del Mar, CA 92625

Phone

(949) 612-2356

Fax

(949) 544-5207

NPI assigned

Mar 31, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 26, 2015 through Jun 26, 2027

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Andrew Spath DDS, Inc

  • Dental Clinic/Center
  • Corona del Mar, CA
  • NPI 1194388231
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1972745362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 E COAST HWY STE 290",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251940",
            "telephone_number": "949-612-2356",
            "fax_number": "949-544-5207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 E COAST HWY STE 290",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "92625",
            "telephone_number": "949-612-2356",
            "fax_number": "949-544-5207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPATH",
        "first_name": "ANDREW",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-31",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "56009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Socaltreatmentcentersllc
• Ihab Ibrahim Soliman, M.D.
• Lee Howard Solow, PH.D.
• South Coast Fitter, LLC
• South Coast Outpatient Surg Ctr Balboa Surgery Center
• Devan Stetson
• Barry Sussman, M.D.
• Stephen Sutherland, M.D.
• Rokhsareh Roxanne Tajrishi, M.D.
• Wing CHI Tang, DPT

• General Practice Dentistry in Corona del Mar, CA
• Providers in Corona del Mar, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.