Healthcare Provider Details

I. General information

NPI: 1780108209
Provider Name (Legal Business Name): AMANDA L. HYLAND D.D.S. P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 INDEPENDENCE DR
MANKATO MN
56001-7767
US

IV. Provider business mailing address

111 STAR ST STE 109
MANKATO MN
56001-4889
US

V. Phone/Fax

Practice location:
  • Phone: 507-387-3249
  • Fax:
Mailing address:
  • Phone: 507-387-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: DR. AMANDA L.E. HYLAND
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 507-387-3249