Individual provider · NPI-1

Andreina Gabriela Acconciagioco, DMD

Dentist, General Practice · Tyler, TX

NPI number1376306027
StatusActive
Last updated in NPPESOct 24, 2024

Details

NPI
1376306027
Entity type
Individual (NPI-1)
Name
Andreina Gabriela Acconciagioco
Credential
DMD
Sex
Female
Sole proprietor
No
Enumeration date
Feb 5, 2024
Certification date
Oct 24, 2024
Last updated
Oct 24, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice41057TXYes
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

2830 W Grande Blvd Apt 14306
Tyler, TX 75703-3595

Phone 346-320-8547

Mailing address

635 Albany St
Boston, MA 02118-3550

Phone 617-358-8300

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