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NPI Code Detail

MEDICARE: DR. KENNETH D ANDRYC D.D.S.

MEDICARE: DR. KENNETH D ANDRYC D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDS018928LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598754921
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH D ANDRYC D.D.S.
Provider Business Mailing Address
First Line : 7686 W RIDGE RD
Second Line : BOX 65
City : FAIRVIEW
State : PA
Zip : 16415-1074
Country : US
Telephone Number : 814-474-1527
Fax Number : 814-474-5022
Provider Business Practice Location Address
First Line : 7686 W RIDGE RD
Second Line : BOX 65
City : FAIRVIEW
State : PA
Zip : 16415-1074
Country : US
Telephone Number : 814-474-1527
Fax Number : 814-474-5022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 12/27/2011

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