Provider Demographics
NPI:1457473100
Name:KEVIN J ANDREWS DDS MS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KEVIN J ANDREWS DDS MS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:775-674-1444
Mailing Address - Street 1:2125 GREEN VISTA DR
Mailing Address - Street 2:#104
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-674-1444
Mailing Address - Fax:775-674-1515
Practice Address - Street 1:2125 GREEN VISTA DR
Practice Address - Street 2:#104
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-674-1444
Practice Address - Fax:775-674-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 2766 SPEC S3451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty