Provider Demographics
NPI:1831286285
Name:ANDELIN, ROBERT KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KAY
Last Name:ANDELIN
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 1:1921 W SYLVESTER ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4850
Mailing Address - Country:US
Mailing Address - Phone:509-547-1791
Mailing Address - Fax:509-547-4383
Practice Address - Street 1:1921 W SYLVESTER ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4850
Practice Address - Country:US
Practice Address - Phone:509-547-1791
Practice Address - Fax:509-547-4383
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000052101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5551106Medicaid