Provider Demographics
NPI:1306080437
Name:DR ROBERT ANDRUS DDS
Entity type:Organization
Organization Name:DR ROBERT ANDRUS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-884-5727
Mailing Address - Street 1:15106 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4096
Mailing Address - Country:US
Mailing Address - Phone:303-884-5727
Mailing Address - Fax:303-282-4708
Practice Address - Street 1:15106 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4096
Practice Address - Country:US
Practice Address - Phone:303-884-5727
Practice Address - Fax:303-282-4708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8161261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10172564Medicaid