Provider Demographics
NPI:1598754921
Name:ANDRYC, KENNETH D (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:ANDRYC
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 1:7686 W RIDGE RD
Mailing Address - Street 2:BOX 65
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1074
Mailing Address - Country:US
Mailing Address - Phone:814-474-1527
Mailing Address - Fax:814-474-5022
Practice Address - Street 1:7686 W RIDGE RD
Practice Address - Street 2:BOX 65
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-1074
Practice Address - Country:US
Practice Address - Phone:814-474-1527
Practice Address - Fax:814-474-5022
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018928L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005084900001Medicaid