Provider Demographics
NPI:1255034930
Name:ZEITLOW, ANDREW EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:EUGENE
Last Name:ZEITLOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANDY
Other - Middle Name:EUGENE
Other - Last Name:ZEITLOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5440 S 119TH CT APT 308
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 N CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4017
Practice Address - Country:US
Practice Address - Phone:316-634-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS620821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program