Provider Demographics
NPI:1205565702
Name:MONELL, ANDREW (DMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MONELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 DEEP WOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4923
Mailing Address - Country:US
Mailing Address - Phone:512-566-1309
Mailing Address - Fax:
Practice Address - Street 1:151 DEEP WOOD DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4923
Practice Address - Country:US
Practice Address - Phone:512-566-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX384091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty