Provider Demographics
NPI:1639392772
Name:ANDREWS, MARK JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:ANDREWS
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 1:7311 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5303
Mailing Address - Country:US
Mailing Address - Phone:425-821-8100
Mailing Address - Fax:425-821-5704
Practice Address - Street 1:7311 NE 141ST ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5303
Practice Address - Country:US
Practice Address - Phone:425-821-8100
Practice Address - Fax:425-821-5704
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000053851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice