Provider Demographics
NPI:1295760353
Name:TOWNSEND, ANDREW LEE (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:TOWNSEND
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 1:934 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-5180
Mailing Address - Country:US
Mailing Address - Phone:517-487-6377
Mailing Address - Fax:
Practice Address - Street 1:934 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5180
Practice Address - Country:US
Practice Address - Phone:517-487-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI109261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4035523Medicaid