MEDICARE: MATTHEW ROBERT ANDELIN DMD

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	122300000X	Dentist	61049374	WA

General Provider Information

NPI Number	:	1891319166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ROBERT ANDELIN DMD

Provider Business Mailing Address
First Line	:	7633 68TH ST NE
Second Line	:
City	:	MARYSVILLE
State	:	WA
Zip	:	98270-6564
Country	:	US
Telephone Number	:	425-345-5340
Fax Number	:

Provider Business Practice Location Address
First Line	:	9612 270TH ST NW STE F
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-1906
Country	:	US
Telephone Number	:	360-629-1776
Fax Number	:

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

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	06/02/2020

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