Individual provider Active NPI

Kenneth L Andow, D.D.S.

  • General Practice Dentistry
  • Centennial, CO
National Provider Identifier
1861612939
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
CO105402 Issued in CO
Practice address
9025 E Mineral Cir Ste 101
Centennial, CO 80112-3449
Phone
(303) 799-1525
NPI assigned
Apr 30, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X CO105402 CO Primary

Addresses

Primary practice location

9025 E Mineral Cir Ste 101
Centennial, CO 80112-3449

Mailing address

9025 E Mineral Cir Ste 101
Centennial, CO 80112-3449
Phone (303) 799-1525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150825003652 CO Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4183930928

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CO105402COMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kenneth L Andow, DDS, PC General Practice Past Accepting new patients
Jeffrey S Tatarin DDS PC PastSince Mar 21, 2021 Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861612939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9025 E MINERAL CIR STE 101",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801123449",
            "telephone_number": "303-799-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9025 E MINERAL CIR STE 101",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801123449",
            "telephone_number": "303-799-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDOW",
        "first_name": "KENNETH",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "CO105402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centennial, CO

Sources for this page

Verify at the official NPI Registry.