MEDICARE: DR. ANDREW K DULANEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2268-86	MS

General Provider Information

NPI Number	:	1710902119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW K DULANEY DMD

Provider Business Mailing Address
First Line	:	135 RANDOM OAK CV
Second Line	:
City	:	RAYMOND
State	:	MS
Zip	:	39154-9651
Country	:	US
Telephone Number	:	601-372-8854
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 BYRAM PLACE
Second Line	:	SUITE C
City	:	JACKSON
State	:	MS
Zip	:	39272-9258
Country	:	US
Telephone Number	:	601-373-1351
Fax Number	:	601-372-7029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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