Provider Demographics
NPI:1609996693
Name:WURTZ, ANDREW BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BRENT
Last Name:WURTZ
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 1:7317 E CHATTAROY RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-8713
Mailing Address - Country:US
Mailing Address - Phone:509-238-1565
Mailing Address - Fax:509-466-6615
Practice Address - Street 1:101 W CASCADE WAY STE 205
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6000
Practice Address - Country:US
Practice Address - Phone:509-466-2595
Practice Address - Fax:509-466-6615
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA73581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice