Provider Demographics
NPI:1841504123
Name:CARRELL, ANDREW JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:CARRELL
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 1:14475 FOREST BLVD N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-7461
Mailing Address - Country:US
Mailing Address - Phone:563-652-3811
Mailing Address - Fax:563-652-3187
Practice Address - Street 1:402 W PLATT ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2161
Practice Address - Country:US
Practice Address - Phone:563-652-3811
Practice Address - Fax:563-652-3187
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist