Healthcare Provider Details

I. General information

NPI: 1174717524
Provider Name (Legal Business Name): ANDREW J TELLINGTON D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MITCHELL RD SE
PORT ORCHARD WA
98366-4401
US

IV. Provider business mailing address

10855 SILVERDALE WAY NW UNIT 1460
SILVERDALE WA
98383-9827
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-8841
  • Fax: 360-895-9350
Mailing address:
  • Phone: 360-895-8841
  • Fax: 360-895-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60426234
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: