Provider Demographics
NPI:1831595917
Name:ANDREWS DENTAL LABORATORIES INC
Entity type:Organization
Organization Name:ANDREWS DENTAL LABORATORIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-875-2222
Mailing Address - Street 1:1338 N CHAPEL ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-2407
Mailing Address - Country:US
Mailing Address - Phone:330-875-2222
Mailing Address - Fax:330-232-9595
Practice Address - Street 1:1338 N CHAPEL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-2407
Practice Address - Country:US
Practice Address - Phone:330-875-2222
Practice Address - Fax:330-232-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074285Medicaid
OH2037076Medicaid