Provider Demographics
NPI:1104168384
Name:PUPKIN, ANDREW I (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:I
Last Name:PUPKIN
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 1:21 CROSSROADS DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5441
Mailing Address - Country:US
Mailing Address - Phone:410-581-1411
Mailing Address - Fax:410-581-2925
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:SUITE 350
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-581-1411
Practice Address - Fax:410-581-2925
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist