Healthcare Provider Details

I. General information

NPI: 1720286727
Provider Name (Legal Business Name): AMANDA EWING D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 FALSE RIVER DR STE C
NEW ROADS LA
70760-2530
US

IV. Provider business mailing address

2312 FALSE RIVER DR. STE C
NEW ROADS LA
70760
US

V. Phone/Fax

Practice location:
  • Phone: 225-638-3384
  • Fax: 225-208-1009
Mailing address:
  • Phone: 225-638-3384
  • Fax: 225-208-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5799
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: