Provider Demographics
NPI:1063203727
Name:ANDREW J KAPUST DDS PS
Entity type:Organization
Organization Name:ANDREW J KAPUST DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAPUST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-791-3985
Mailing Address - Street 1:344 CLEVELAND AVE SE STE J
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3342
Mailing Address - Country:US
Mailing Address - Phone:360-791-3985
Mailing Address - Fax:
Practice Address - Street 1:344 CLEVELAND AVE SE STE J
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3342
Practice Address - Country:US
Practice Address - Phone:360-790-4578
Practice Address - Fax:360-790-4578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREW J KAPUST DDS PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty