Provider Demographics
NPI:1487629002
Name:JONES, ANDREW THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
Last Name:JONES
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 1:5219 ST JOHN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NETT LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55772-8232
Mailing Address - Country:US
Mailing Address - Phone:218-757-3295
Mailing Address - Fax:218-757-0234
Practice Address - Street 1:5219 ST JOHN DRIVE
Practice Address - Street 2:
Practice Address - City:NETT LAKE
Practice Address - State:MN
Practice Address - Zip Code:55772-8232
Practice Address - Country:US
Practice Address - Phone:218-757-3295
Practice Address - Fax:218-757-0234
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND116791223G0001X
IA08162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN769473300Medicaid
MND11679OtherSTATE LICENSE