Healthcare Provider Details

I. General information

NPI: 1720769326
Provider Name (Legal Business Name): AMBER DURAND DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/17/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2537
US

IV. Provider business mailing address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN123389
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD14976
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: