Andrew Thomas Jones, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11679 Issued in MN

Practice address

5219 St John Drive
Nett Lake, MN 55772-8232

Phone

(218) 757-3295

Fax

(218) 757-0234

NPI assigned

Feb 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1487629002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 ST JOHN DRIVE",
            "city": "NETT LAKE",
            "state": "MN",
            "postal_code": "557728232",
            "telephone_number": "218-757-3295",
            "fax_number": "218-757-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5219 ST JOHN DRIVE",
            "city": "NETT LAKE",
            "state": "MN",
            "postal_code": "557728232",
            "telephone_number": "218-757-3295",
            "fax_number": "218-757-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "ANDREW",
        "middle_name": "THOMAS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "769473300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "D11679",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bois Forte Reservation Tribal Council
• Bois Forte Reservation Tribal Government
• Bois Forte Reservation Tribal Government
• Melissa Joan Grzybowski
• Lance E Hardwig, P.A,
• Julie Skoglund, PHARMD
• St. Louis & Koochiching Cos Ind School Dist 707
• Shanna Rachelle Vidor, M.D.
• Joe Witt, LP

• General Practice Dentistry in Nett Lake, MN
• Providers in Nett Lake, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.