Provider Demographics
NPI:1508976390
Name:DONALDSON, ANDREW E SR (DMD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:E
Last Name:DONALDSON
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-887-2615
Mailing Address - Fax:334-887-2619
Practice Address - Street 1:1216 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:334-887-2615
Practice Address - Fax:334-887-2619
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL5120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51518427OtherBLUE CROSS BLUE SHIELD
1359704OtherUNITED CONCORDIA