Provider Demographics
NPI:1558423293
Name:MCDANIEL, ANDREW WINSLOW (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WINSLOW
Last Name:MCDANIEL
Suffix:
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 1:2811 S LOOP 289
Mailing Address - Street 2:UNIT 12
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1488
Mailing Address - Country:US
Mailing Address - Phone:806-748-9797
Mailing Address - Fax:
Practice Address - Street 1:2811 S LOOP 289
Practice Address - Street 2:UNIT 12
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1488
Practice Address - Country:US
Practice Address - Phone:806-748-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230871223G0001X
GADN0121991223G0001X
VA04014106941223G0001X
SC37741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice