MEDICARE: DR. AMANDA MARIE SANDIFER 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	1223G0001X	General Practice Dentistry	6669	LA

General Provider Information

NPI Number	:	1760831226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA MARIE SANDIFER DDS

Provider Business Mailing Address
First Line	:	18444 RED OAK DR
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-3756
Country	:	US
Telephone Number	:	222-270-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	563 COLONIAL DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6553
Country	:	US
Telephone Number	:	225-275-0123
Fax Number	:

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

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	06/06/2016

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