Healthcare Provider Details

I. General information

NPI: 1043831860
Provider Name (Legal Business Name): AMANDA LAUREN MORGENTHAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 BROADWAY BLUFFS DR STE 200
COLUMBIA MO
65201-8147
US

IV. Provider business mailing address

1245 SE 3RD ST STE A1
BEND OR
97702-2162
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-9282
  • Fax:
Mailing address:
  • Phone: 541-318-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD11626
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: