Provider Demographics
NPI:1518245349
Name:ANDREWS, KELLY CONLIN
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CONLIN
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0092
Mailing Address - Country:US
Mailing Address - Phone:866-268-9631
Mailing Address - Fax:541-504-3907
Practice Address - Street 1:9900 SW GREENBURG RD STE 240
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5454
Practice Address - Country:US
Practice Address - Phone:503-443-3842
Practice Address - Fax:541-504-3907
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist