Provider Demographics
NPI:1902933385
Name:PICKENS, ANDREW W (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:PICKENS
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 1:730 MAIN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105
Mailing Address - Country:US
Mailing Address - Phone:406-256-2121
Mailing Address - Fax:406-294-2120
Practice Address - Street 1:730 MAIN
Practice Address - Street 2:SUITE 101
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105
Practice Address - Country:US
Practice Address - Phone:406-256-2121
Practice Address - Fax:406-294-2120
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT112905Medicaid