MEDICARE: DR. AMANDA JO STEFFES DDS

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	D14770	MN

General Provider Information

NPI Number	:	1417684218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA JO STEFFES DDS

Provider Business Mailing Address
First Line	:	1235 2ND ST
Second Line	:
City	:	SAINT PAUL PARK
State	:	MN
Zip	:	55071-1741
Country	:	US
Telephone Number	:	218-329-7255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 E 66TH ST
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2722
Country	:	US
Telephone Number	:	218-329-7255
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/11/2022

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