1114041464 NPI number — JEFFREY LANE ANDREWS DDS

Table of content: (NPI 1528206547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114041464 NPI number — JEFFREY LANE ANDREWS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
JEFFREY
Provider Middle Name:
LANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114041464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DREW
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38737-3420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-745-6669
Provider Business Mailing Address Fax Number:
662-745-6150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DREW
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38737-3420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-745-6669
Provider Business Practice Location Address Fax Number:
662-745-6150
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  252990 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00060419 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com