Andrew Monteith Macconnell, DDS, MIIF, DABOI/ID

Primary specialty

DentistTaxonomy code 122300000X

License

DS0000009226 Issued in TN

Practice address

4453 Highway 11 E
Bluff City, TN 37618-2456

Phone

(423) 391-8004

Fax

(423) 391-8006

NPI assigned

Nov 22, 2010

Last updated

Sep 17, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1290384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1851693048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 297",
            "city": "BLUFF CITY",
            "state": "TN",
            "postal_code": "376180297",
            "telephone_number": "423-391-8004",
            "fax_number": "423-391-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4453 HIGHWAY 11 E",
            "city": "BLUFF CITY",
            "state": "TN",
            "postal_code": "376182456",
            "telephone_number": "423-391-8004",
            "fax_number": "423-391-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACCONNELL",
        "first_name": "ANDREW",
        "middle_name": "MONTEITH",
        "name_prefix": "Dr.",
        "credential": "DDS, MIIF, DABOI/ID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-22",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN009951",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "DS0000009226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Bluff City, TN
• Providers in Bluff City, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.