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General NPI Number Information
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NPI Number | 1871983262
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Entity Type | Organization
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Legal Business Name | ANDROS ORTHODONTICS PS
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 5701 BEDFORD ST
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City | PASCO
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State | WA
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Zip | 99301-8214
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Country | US
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Telephone | 509-792-1008
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Fax | 509-792-1048
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Provider Business Mailing Address
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Address Line | 5701 BEDFORD ST
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City | PASCO
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State | WA
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Zip | 99301-8214
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Country | US
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Telephone | 509-792-1008
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Fax | 509-792-1048
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NICHOLAS DAVID ANDROS
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Credential | D.D.S.
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Telephone | 509-792-1008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DE60247879
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License Number State | WA
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