MEDICARE: MARSHA AMANDA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25146	TX

General Provider Information

NPI Number	:	1134456247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA AMANDA DMD

Provider Business Mailing Address
First Line	:	1319 GEORGE DIETER DR STE G
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7483
Country	:	US
Telephone Number	:	855-377-7433
Fax Number	:	855-377-7433

Provider Business Practice Location Address
First Line	:	1319 GEORGE DIETER DR STE G
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7483
Country	:	US
Telephone Number	:	855-377-7433
Fax Number	:	855-377-7433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	04/11/2016

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Directions to “ MARSHA AMANDA DMD” Practice Location

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