Andrew Robert Mullendore, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30-023253 Issued in OH

Practice address

6555 E Broad St
Columbus, OH 43213-1509

Phone

(614) 427-0400

NPI assigned

Jun 15, 2006

Last updated

Dec 13, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 19, 2023 through Jan 19, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East Columbus Oral Surgery Specialists Inc.

  dba East Columbus Oral Surgery Specialists

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Columbus, OH
  • NPI 1831543701
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1649214164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6555 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131509",
            "telephone_number": "614-427-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 E BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432131509",
            "telephone_number": "614-427-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLENDORE",
        "first_name": "ANDREW",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2004012411",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30-023253",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OH",
            "license": "096558",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marianne Mullan, MA
• Sophia J Mulle
• April Mullen
• Jennifer Sue Mullen
• Karen Mullen, LPN
• Irene Mullenix, MA, PCC
• Rachel Mullens, PARAPROFESSIONAL
• Chrysencia Muller
• James Muller, DO
• Winston Tyler Mullet

• Oral and Maxillofacial Surgery (Dentist) in Columbus, OH
• Providers in Columbus, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.