Provider Demographics
NPI:1275746976
Name:ANDRE KANDY, DDS, PA
Entity Type:Organization
Organization Name:ANDRE KANDY, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-684-2836
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty