Provider Demographics
NPI:1245278647
Name:ALTHAUSER, ANDREW C (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:ALTHAUSER
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 1:1547 S HIGGINS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4226
Mailing Address - Country:US
Mailing Address - Phone:406-549-2778
Mailing Address - Fax:406-728-6160
Practice Address - Street 1:1547 S HIGGINS AVE STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4226
Practice Address - Country:US
Practice Address - Phone:406-549-2778
Practice Address - Fax:406-728-6160
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist