Provider Demographics
NPI:1376010777
Name:ANDRADE, AIME (RDH)
Entity Type:Individual
Prefix:
First Name:AIME
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 SHAWNEE MISSION PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2518
Mailing Address - Country:US
Mailing Address - Phone:913-254-4065
Mailing Address - Fax:
Practice Address - Street 1:4400 SHAWNEE MISSION PKWY STE 208
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2518
Practice Address - Country:US
Practice Address - Phone:913-254-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12451124Q00000X
MO2017044311124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist