Provider Demographics
NPI:1477757292
Name:ORR, ANDREW GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GEORGE
Last Name:ORR
Suffix:
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 1:7249 GAP RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3688
Mailing Address - Country:US
Mailing Address - Phone:870-897-6141
Mailing Address - Fax:
Practice Address - Street 1:1405 BRADEN STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3720
Practice Address - Country:US
Practice Address - Phone:501-241-2345
Practice Address - Fax:501-985-8081
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164449608Medicaid