Provider Demographics
NPI:1033234984
Name:KANDY, ANDRE (DDS)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:KANDY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4935
Mailing Address - Country:US
Mailing Address - Phone:316-684-2836
Mailing Address - Fax:316-684-5591
Practice Address - Street 1:212 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4935
Practice Address - Country:US
Practice Address - Phone:316-684-2836
Practice Address - Fax:316-684-5591
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice