Provider Demographics
NPI:1154487593
Name:VANBLARCOM, ANDREW BLAKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BLAKE
Last Name:VANBLARCOM
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 1:5000 W 95TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-3300
Mailing Address - Country:US
Mailing Address - Phone:913-649-4946
Mailing Address - Fax:913-649-2460
Practice Address - Street 1:5000 W 95TH ST STE 290
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-3300
Practice Address - Country:US
Practice Address - Phone:913-649-4946
Practice Address - Fax:913-649-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602771223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR770000Medicare ID - Type Unspecified
KSU87963Medicare UPIN