Healthcare Provider Details

I. General information

NPI: 1902211576
Provider Name (Legal Business Name): AMANDA BETH PATTERSON D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2834 N RAMSEY RD # 102-103
COEUR D ALENE ID
83815-9003
US

IV. Provider business mailing address

2834 N RAMSEY RD # 102-103
COEUR D ALENE ID
83815-9003
US

V. Phone/Fax

Practice location:
  • Phone: 208-415-0299
  • Fax:
Mailing address:
  • Phone: 208-667-1546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-5629
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: