Provider Demographics
NPI:1245448331
Name:TARKINGTON, ANDREW CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHARLES
Last Name:TARKINGTON
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 1:215 S RIPLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4003
Mailing Address - Country:US
Mailing Address - Phone:989-354-8340
Mailing Address - Fax:
Practice Address - Street 1:215 S RIPLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4003
Practice Address - Country:US
Practice Address - Phone:989-354-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI121611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice