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General NPI Number Information
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NPI Number | 1851693048
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Entity Type | Individual
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Provider Name | ANDREW MONTEITH MACCONNELL DDS, MIIF, DABOI/ID
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Gender | Male
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 4453 HIGHWAY 11 E
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City | BLUFF CITY
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State | TN
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Zip | 37618-2456
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Country | US
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Telephone | 423-391-8004
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Fax | 423-391-8006
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Provider Business Mailing Address
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Address Line | PO BOX 297
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City | BLUFF CITY
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State | TN
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Zip | 37618-0297
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Country | US
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Telephone | 423-391-8004
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Fax | 423-391-8006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN009951
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0000009226
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License Number State | TN
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