Provider Demographics
NPI:1538560743
Name:KLISH, ANDREW JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:KLISH
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:BLDG 9900, LINCOLN STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JB LEWIS-MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98433
Mailing Address - Country:US
Mailing Address - Phone:210-221-0826
Mailing Address - Fax:
Practice Address - Street 1:9059 GARDNER LOOP RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JB LEWIS-MCCHORT
Practice Address - State:WA
Practice Address - Zip Code:98433-0000
Practice Address - Country:US
Practice Address - Phone:240-344-7852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice