Provider Demographics
NPI:1598941775
Name:ANDREWS DENTAL CARE, PLLC
Entity Type:Organization
Organization Name:ANDREWS DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:LEO-NARD
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-477-0994
Mailing Address - Street 1:2270 MATLOCK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3709
Mailing Address - Country:US
Mailing Address - Phone:817-477-0994
Mailing Address - Fax:817-453-5450
Practice Address - Street 1:2270 MATLOCK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3709
Practice Address - Country:US
Practice Address - Phone:817-477-0994
Practice Address - Fax:817-453-5450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREWS DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty