Provider Demographics
NPI:1649478355
Name:KIRSIS, ANDRIS V (DDS)
Entity type:Individual
Prefix:MR
First Name:ANDRIS
Middle Name:V
Last Name:KIRSIS
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 1:2901 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-4041
Mailing Address - Country:US
Mailing Address - Phone:515-279-6413
Mailing Address - Fax:515-277-9847
Practice Address - Street 1:2901 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-4041
Practice Address - Country:US
Practice Address - Phone:515-279-6413
Practice Address - Fax:515-277-9847
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice