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General NPI Number Information
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NPI Number | 1841996675
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Entity Type | Individual
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Provider Name | AMANDA LACERDA DMD
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Gender | Female
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 11230 SORRENTO VALLEY RD STE 130
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City | SAN DIEGO
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State | CA
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Zip | 92121-1338
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Country | US
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Telephone | 858-682-2921
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 COLUMBIA ST APT 1403
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City | SAN DIEGO
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State | CA
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Zip | 92101-3475
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Country | US
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Telephone | 619-510-9895
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS107558
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS107558
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License Number State | CA
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