Provider Demographics
NPI:1043209943
Name:ANDREWS, WILLIAM FARR JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FARR
Last Name:ANDREWS
Suffix:JR
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 1:67 BOLIVAR HWY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-7810
Mailing Address - Country:US
Mailing Address - Phone:731-423-2278
Mailing Address - Fax:731-424-6131
Practice Address - Street 1:67 BOLIVAR HWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7810
Practice Address - Country:US
Practice Address - Phone:731-423-2278
Practice Address - Fax:731-424-6131
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS25101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2002169OtherBLUE CROSS BLUE SHIELD
TN3217683Medicaid