Provider Demographics
NPI:1760648091
Name:ORDELHEIDE, ANDREW TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TIMOTHY
Last Name:ORDELHEIDE
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0837
Mailing Address - Country:US
Mailing Address - Phone:406-826-3611
Mailing Address - Fax:406-826-3613
Practice Address - Street 1:200 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859
Practice Address - Country:US
Practice Address - Phone:406-215-4705
Practice Address - Fax:406-258-0612
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2416122300000X
CA572341223G0001X
MT2461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57234OtherSTATE LICENSE
MT2461OtherMONTANA STATE BOARD OF DENTISTRY
HI2416OtherSTATE DENTAL BOARD OF HAWAII