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General NPI Number Information
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NPI Number | 1174717524
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Entity Type | Individual
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Provider Name | ANDREW J TELLINGTON D.M.D
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Gender | Male
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 727 ERICKSEN AVE NE STE 2
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City | BAINBRIDGE ISLAND
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State | WA
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Zip | 98110-1882
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Country | US
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Telephone | 206-842-8135
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Fax |
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Provider Business Mailing Address
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Address Line | 10855 SILVERDALE WAY NW UNIT 1460
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City | SILVERDALE
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State | WA
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Zip | 98383-9827
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Country | US
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Telephone | 360-895-8841
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Fax | 360-895-9350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D4095
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE60426234
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License Number State | WA
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