Healthcare Provider Details

I. General information

NPI: 1164111670
Provider Name (Legal Business Name): AMANDA WOOD PHARO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W ELLIOT RD
CHANDLER AZ
85225-1885
US

IV. Provider business mailing address

801 W ELLIOT RD
CHANDLER AZ
85225-1885
US

V. Phone/Fax

Practice location:
  • Phone: 480-602-0414
  • Fax:
Mailing address:
  • Phone: 480-602-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011923
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: