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General NPI Number Information
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NPI Number | 1396194478
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Entity Type | Individual
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Provider Name | AMANDA DEWUNDARA DDS
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 110 LOCKWOOD AVE STE 201
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5011
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Country | US
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Telephone | 248-252-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 370 W 127TH ST APT 5A
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City | NEW YORK
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State | NY
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Zip | 10027-3554
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Country | US
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Telephone | 124-825-2040
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 060071-1
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License Number State | NY
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