Healthcare Provider Details

I. General information

NPI: 1972449601
Provider Name (Legal Business Name): AMANDA LAW DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WARREN ST
BRIGHTON MA
02135-3602
US

IV. Provider business mailing address

13579 CRYSTAL RIVER DR
ORLANDO FL
32828-8444
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-3800
  • Fax:
Mailing address:
  • Phone: 407-459-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: