Provider Demographics
NPI:1811252166
Name:ANDREWS, PAUL AARON (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:AARON
Last Name:ANDREWS
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 1:3820 PACIFIC AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7825
Mailing Address - Country:US
Mailing Address - Phone:253-472-3006
Mailing Address - Fax:
Practice Address - Street 1:3820 PACIFIC AVE
Practice Address - Street 2:STE. 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7825
Practice Address - Country:US
Practice Address - Phone:253-472-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2017931223G0001X
WADE 603162291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023357Medicaid