Provider Demographics
NPI:1508248501
Name:HERWIG, ANDREW VAUGHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:VAUGHAN
Last Name:HERWIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 W 87TH STREET PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2807
Mailing Address - Country:US
Mailing Address - Phone:913-492-8884
Mailing Address - Fax:913-492-4582
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-492-8884
Practice Address - Fax:913-492-4582
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist