Healthcare Provider Details

I. General information

NPI: 1770293706
Provider Name (Legal Business Name): AMANDA SPRINGER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5376 BIG TYLER RD
CROSS LANES WV
25313-1059
US

IV. Provider business mailing address

5376 BIG TYLER RD
CROSS LANES WV
25313-1059
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-2223
  • Fax: 304-776-2223
Mailing address:
  • Phone: 304-776-2223
  • Fax: 304-776-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMANDA SPRINGER
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 304-776-2223