Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 60277 | KS |
NPI | 1154487593 |
---|---|
Provider Name | Dr. Andrew Blake Vanblarcom |
First Address | Prairie Village, KS 66207-3300 |
Second Address | Prairie Village, KS 66207-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U87963 | (02) | KS |