Healthcare Provider Details

I. General information

NPI: 1942802301
Provider Name (Legal Business Name): ANDREW J. TELLINGTON DMD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
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 Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW TELLINGTON
Title or Position: PRESIDENT
Credential: DMD
Phone: 360-895-8841