Provider Demographics
NPI:1821157603
Name:MOHLMAN, ANDREW TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TODD
Last Name:MOHLMAN
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 1:554 N COLORADO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6711
Mailing Address - Country:US
Mailing Address - Phone:509-736-2318
Mailing Address - Fax:509-735-7210
Practice Address - Street 1:554 N COLORADO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6711
Practice Address - Country:US
Practice Address - Phone:509-736-2318
Practice Address - Fax:509-735-7210
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE102481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5048855Medicaid