Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 10441 | CO |
NPI | 1134359193 |
---|---|
Provider Name | Kevin H Andrus |
First Address | Lakewood, CO 80232-7102 |
Second Address | Lakewood, CO 80232-7102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 20/02/2012 |