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NPI Code Detail

MEDICARE: AMANDA L NEWCITY DMD

MEDICARE:   AMANDA L NEWCITY  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
1122300000XDentistDN19991FL

General Provider Information

NPI Number : 1457615668
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA L NEWCITY DMD
Provider Business Mailing Address
First Line : 13110 ELK MOUNTAIN DR
Second Line :
City : RIVERVIEW
State : FL
Zip : 33579-7182
Country : US
Telephone Number : 813-653-6208
Fax Number : 813-685-2110
Provider Business Practice Location Address
First Line : 313 S LAKEWOOD DR
Second Line :
City : BRANDON
State : FL
Zip : 33511-2815
Country : US
Telephone Number : 727-542-5609
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2012
Last Update Date : 03/15/2017

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Directions to “ AMANDA L NEWCITY DMD” Practice Location

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