Provider Demographics
NPI:1104806918
Name:KAPUST, ANDREW J (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:KAPUST
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 1:344 CLEVELAND AVE SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3342
Mailing Address - Country:US
Mailing Address - Phone:360-943-6600
Mailing Address - Fax:360-754-0898
Practice Address - Street 1:344 CLEVELAND AVE SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3342
Practice Address - Country:US
Practice Address - Phone:360-943-6600
Practice Address - Fax:360-754-0898
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA67381223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics