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General NPI Number Information
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NPI Number | 1922284470
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Entity Type | Organization
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Legal Business Name | AMANDA CERQUEIRA, DDS, PA
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 1328 N LAKE PARK BLVD STE. 107
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City | CAROLINA BEACH
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State | NC
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Zip | 28428-3935
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Country | US
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Telephone | 910-458-3232
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Fax | 910-458-3253
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Provider Business Mailing Address
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Address Line | 1328 N LAKE PARK BLVD STE. 107
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City | CAROLINA BEACH
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State | NC
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Zip | 28428-3935
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Country | US
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Telephone | 910-458-3232
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Fax | 910-458-3253
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JOSE DANIEL CERQUEIRA
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Credential |
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Telephone | 910-458-3232
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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 | 7597
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License Number State | NC
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