Provider Demographics
NPI:1972953149
Name:ANDRUS, CHRISTIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 S JOPLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-4155
Mailing Address - Country:US
Mailing Address - Phone:951-533-0163
Mailing Address - Fax:
Practice Address - Street 1:12190 S WACO AVE STE B
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-5661
Practice Address - Country:US
Practice Address - Phone:951-533-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice