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General NPI Number Information
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NPI Number | 1821661463
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Entity Type | Individual
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Provider Name | AMANDA MANN DMD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 07/21/2021
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Provider Practice Location Address
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Address Line | 517 E 5TH ST
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City | HUNTINGBURG
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State | IN
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Zip | 47542-1004
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Country | US
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Telephone | 859-358-0711
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Fax |
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Provider Business Mailing Address
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Address Line | 857 KEUSCH LN
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City | JASPER
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State | IN
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Zip | 47546-2987
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Country | US
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Telephone | 859-358-0711
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12013674A
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License Number State | IN
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