Provider Demographics
NPI:1134359193
Name:ANDRUS, KEVIN H (DDS, MS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:H
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ENCINITAS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3782
Mailing Address - Country:US
Mailing Address - Phone:760-944-0048
Mailing Address - Fax:
Practice Address - Street 1:531 ENCINITAS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3782
Practice Address - Country:US
Practice Address - Phone:760-944-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1087711223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics