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General NPI Number Information
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NPI Number | 1114748282
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Entity Type | Individual
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Provider Name | AMANDA DEBOER RDH
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 395 MAIN STREET LOOP
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City | KENAI
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State | AK
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Zip | 99611-7727
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Country | US
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Telephone | 907-283-7759
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Fax | 907-283-4883
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Provider Business Mailing Address
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Address Line | PO BOX 2949
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City | SOLDOTNA
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State | AK
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Zip | 99669-2949
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Country | US
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Telephone | 907-283-7759
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Fax | 907-283-4883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 200346
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License Number State | AK
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