Provider Demographics
NPI:1225230881
Name:ANDREWS, KIRSTEN ANNELIESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ANNELIESE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3015
Mailing Address - Country:US
Mailing Address - Phone:701-662-4961
Mailing Address - Fax:
Practice Address - Street 1:503 3RD ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3015
Practice Address - Country:US
Practice Address - Phone:701-662-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41418Medicaid