Provider Demographics
NPI:1831469204
Name:ANDROS, NICHOLAS D (DDS)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:D
Last Name:ANDROS
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 1:5 ROSE CT
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-1895
Mailing Address - Country:US
Mailing Address - Phone:509-430-8477
Mailing Address - Fax:
Practice Address - Street 1:5 ROSE CT
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-1895
Practice Address - Country:US
Practice Address - Phone:509-430-8477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60247879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist