Provider Demographics
NPI:1508351602
Name:TUGGLE, ANDIE (DMD)
Entity Type:Individual
Prefix:
First Name:ANDIE
Middle Name:
Last Name:TUGGLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 CHEYENNE LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-9613
Mailing Address - Country:US
Mailing Address - Phone:046-308-3444
Mailing Address - Fax:
Practice Address - Street 1:1215 VINE ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2535
Practice Address - Country:US
Practice Address - Phone:770-532-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist