Provider Demographics
NPI:1275916777
Name:ANDRUS PROSTHODONTICS LC
Entity Type:Organization
Organization Name:ANDRUS PROSTHODONTICS LC
Other - Org Name:ST.GEORGE CENTER FOR SPECIALIZED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-674-3100
Mailing Address - Street 1:640 E 700 S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4023
Mailing Address - Country:US
Mailing Address - Phone:435-674-3100
Mailing Address - Fax:435-674-4345
Practice Address - Street 1:640 E 700 S
Practice Address - Street 2:SUITE 104
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4023
Practice Address - Country:US
Practice Address - Phone:435-674-3100
Practice Address - Fax:435-674-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4748653335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier