1831301340 NPI number — ANDREW VAN BLARCOM, DDS, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831301340 NPI number — ANDREW VAN BLARCOM, DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDREW VAN BLARCOM, DDS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831301340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 WEST 95TH STREET
Provider Second Line Business Mailing Address:
SUITE NUMBER 290
Provider Business Mailing Address City Name:
PRAIRIE VILLAGE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-649-4946
Provider Business Mailing Address Fax Number:
913-649-2460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 WEST 95TH STREET
Provider Second Line Business Practice Location Address:
SUITE NUMBER 290
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-649-4946
Provider Business Practice Location Address Fax Number:
913-649-2460
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN BLARCOM
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
BLAKE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-649-4946

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  60277 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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