Provider Demographics
NPI:1912578675
Name:VLOSICH, ANDREW JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:VLOSICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:JOHN
Other - Last Name:VLOSICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5706 FOXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7407
Mailing Address - Country:US
Mailing Address - Phone:806-223-6255
Mailing Address - Fax:
Practice Address - Street 1:3503 S SONCY RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6401
Practice Address - Country:US
Practice Address - Phone:806-374-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist