MEDICARE: DR. ANDREW C MEDLIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2013015327	MO

General Provider Information

NPI Number	:	1851738975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW C MEDLIN DDS

Provider Business Mailing Address
First Line	:	3515 BROADWAY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2501
Country	:	US
Telephone Number	:	816-753-5144
Fax Number	:	855-737-0585

Provider Business Practice Location Address
First Line	:	2340 E MEYER BLVD STE 200
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64132-1121
Country	:	US
Telephone Number	:	816-753-5144
Fax Number	:	855-737-0585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	03/04/2024

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