Provider Demographics
NPI:1225124647
Name:MCCANLESS, ANDREW LEE SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LEE
Last Name:MCCANLESS
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:2805 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:STE 113
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8170
Mailing Address - Country:US
Mailing Address - Phone:770-476-2252
Mailing Address - Fax:770-476-3798
Practice Address - Street 1:5635 PEACHTREE PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2812
Practice Address - Country:US
Practice Address - Phone:770-448-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA96471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice