Provider Demographics
NPI:1831301340
Name:ANDREW VAN BLARCOM, DDS, PA
Entity Type:Organization
Organization Name:ANDREW VAN BLARCOM, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:VAN BLARCOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-649-4946
Mailing Address - Street 1:5000 WEST 95TH STREET
Mailing Address - Street 2:SUITE NUMBER 290
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207
Mailing Address - Country:US
Mailing Address - Phone:913-649-4946
Mailing Address - Fax:913-649-2460
Practice Address - Street 1:5000 WEST 95TH STREET
Practice Address - Street 2:SUITE NUMBER 290
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207
Practice Address - Country:US
Practice Address - Phone:913-649-4946
Practice Address - Fax:913-649-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602771223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU87963Medicare UPIN
KSR770000Medicare ID - Type Unspecified