Provider Demographics
NPI:1851738975
Name:MEDLIN, ANDREW C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:MEDLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3515 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2501
Mailing Address - Country:US
Mailing Address - Phone:816-753-5144
Mailing Address - Fax:855-737-0585
Practice Address - Street 1:2340 E MEYER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1121
Practice Address - Country:US
Practice Address - Phone:816-753-5144
Practice Address - Fax:855-737-0585
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130153271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice