Provider Demographics
NPI:1114041464
Name:ANDREWS, JEFFREY LANE (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LANE
Last Name:ANDREWS
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 1:131 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DREW
Mailing Address - State:MS
Mailing Address - Zip Code:38737-3420
Mailing Address - Country:US
Mailing Address - Phone:662-745-6669
Mailing Address - Fax:662-745-6150
Practice Address - Street 1:131 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DREW
Practice Address - State:MS
Practice Address - Zip Code:38737-3420
Practice Address - Country:US
Practice Address - Phone:662-745-6669
Practice Address - Fax:662-745-6150
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS252990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060419Medicaid
MSBA2408208OtherDEA LICENSE