Healthcare Provider Details

I. General information

NPI: 1952141871
Provider Name (Legal Business Name): AMANDA BAIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 AVENUE D STE 100
SNOHOMISH WA
98290-2081
US

IV. Provider business mailing address

1001 AVENUE D STE 100
SNOHOMISH WA
98290-2081
US

V. Phone/Fax

Practice location:
  • Phone: 360-568-9694
  • Fax:
Mailing address:
  • Phone: 360-568-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDENT.DE.70151765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: