Provider Demographics
NPI:1710902119
Name:DULANEY, ANDREW K (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:K
Last Name:DULANEY
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 1:135 RANDOM OAK CV
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:MS
Mailing Address - Zip Code:39154-9651
Mailing Address - Country:US
Mailing Address - Phone:601-372-8854
Mailing Address - Fax:
Practice Address - Street 1:310 BYRAM PLACE
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39272-9258
Practice Address - Country:US
Practice Address - Phone:601-373-1351
Practice Address - Fax:601-372-7029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2268-861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice