Healthcare Provider Details

I. General information

NPI: 1528766060
Provider Name (Legal Business Name): AMANDA CARLOS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WASHINGTON ST
GLOUCESTER MA
01930-4836
US

IV. Provider business mailing address

19 WASHINGTON ST APT 9
HAVERHILL MA
01832-5704
US

V. Phone/Fax

Practice location:
  • Phone: 978-282-8899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10000284
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: