MEDICARE: AMANDA JILLAIN DARLING D.D.S.

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	2008005853	MO

General Provider Information

NPI Number	:	1982829917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JILLAIN DARLING D.D.S.

Provider Business Mailing Address
First Line	:	485 WILDWOOD PKWY
Second Line	:	SUITE 5
City	:	BALLWIN
State	:	MO
Zip	:	63011-2667
Country	:	US
Telephone Number	:	636-227-8400
Fax Number	:	636-227-8403

Provider Business Practice Location Address
First Line	:	485 WILDWOOD PKWY
Second Line	:	SUITE 5
City	:	BALLWIN
State	:	MO
Zip	:	63011-2667
Country	:	US
Telephone Number	:	636-227-8400
Fax Number	:	636-227-8403

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	05/01/2008

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