Healthcare Provider Details

I. General information

NPI: 1497257372
Provider Name (Legal Business Name): AMANDA DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 W GONZALES RD STE 300
OXNARD CA
93036-9003
US

IV. Provider business mailing address

451 W GONZALES RD STE 300
OXNARD CA
93036-9003
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberLIMITED
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: