Healthcare Provider Details

I. General information

NPI: 1053849208
Provider Name (Legal Business Name): KYRIACOS ANDRONIKOU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date: 01/05/2018
Reactivation Date: 02/13/2018

III. Provider practice location address

3055 WASHINGTON RD STE 303
MC MURRAY PA
15317-3279
US

IV. Provider business mailing address

3055 WASHINGTON RD STE 303
MC MURRAY PA
15317-3279
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-5630
  • Fax: 724-942-5632
Mailing address:
  • Phone: 724-942-5630
  • Fax: 724-942-5632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS041200
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: