Provider Demographics
NPI:1518079896
Name:ANDREWS, JESSIE L (DDS)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:ANDREWS
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 1:2270 MATLOCK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3710
Mailing Address - Country:US
Mailing Address - Phone:817-477-0994
Mailing Address - Fax:817-453-5450
Practice Address - Street 1:2270 MATLOCK RD STE 102
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3710
Practice Address - Country:US
Practice Address - Phone:817-477-0994
Practice Address - Fax:817-453-5450
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist