Provider Demographics
NPI:1851693048
Name:MACCONNELL, ANDREW MONTEITH (DDS, MIIF, DABOI/ID)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MONTEITH
Last Name:MACCONNELL
Suffix:
Gender:M
Credentials:DDS, MIIF, DABOI/ID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:BLUFF CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37618-0297
Mailing Address - Country:US
Mailing Address - Phone:423-391-8004
Mailing Address - Fax:423-391-8006
Practice Address - Street 1:4453 HIGHWAY 11 E
Practice Address - Street 2:
Practice Address - City:BLUFF CITY
Practice Address - State:TN
Practice Address - Zip Code:37618-2456
Practice Address - Country:US
Practice Address - Phone:423-391-8004
Practice Address - Fax:423-391-8006
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009951122300000X
TNDS0000009226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist