Provider Demographics
NPI:1174717524
Name:TELLINGTON, ANDREW J (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:TELLINGTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10855 SILVERDALE WAY NW UNIT 1460
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9827
Mailing Address - Country:US
Mailing Address - Phone:360-895-8841
Mailing Address - Fax:360-895-9350
Practice Address - Street 1:727 ERICKSEN AVE NE STE 2
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1882
Practice Address - Country:US
Practice Address - Phone:206-842-8135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD40951223G0001X
WADE604262341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice