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General NPI Number Information
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NPI Number | 1831301340
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Entity Type | Organization
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Legal Business Name | ANDREW VAN BLARCOM, DDS, PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5000 WEST 95TH STREET SUITE NUMBER 290
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207
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Country | US
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Telephone | 913-649-4946
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Fax | 913-649-2460
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Provider Business Mailing Address
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Address Line | 5000 WEST 95TH STREET SUITE NUMBER 290
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207
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Country | US
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Telephone | 913-649-4946
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Fax | 913-649-2460
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW BLAKE VAN BLARCOM
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Credential | D.D.S.
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Telephone | 913-649-4946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 60277
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License Number State | KS
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