Healthcare Provider Details

I. General information

NPI: 1922412816
Provider Name (Legal Business Name): AMANDA SMITH DMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRAFALGAR SQ STE 103
NASHUA NH
03063-1998
US

IV. Provider business mailing address

1 TRAFALGAR SQ STE 103
NASHUA NH
03063-1998
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-3000
  • Fax:
Mailing address:
  • Phone: 603-880-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04055
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: