MEDICARE: DR. AMANDA GREENLEE BOURFF 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	12010671A	IN

General Provider Information

NPI Number	:	1891911723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA GREENLEE BOURFF DDS

Provider Business Mailing Address
First Line	:	55 BRENDON WAY STE 200
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1955
Country	:	US
Telephone Number	:	317-873-6750
Fax Number	:	317-873-6708

Provider Business Practice Location Address
First Line	:	55 BRENDON WAY STE 200
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-1955
Country	:	US
Telephone Number	:	317-873-6750
Fax Number	:	317-873-6708

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/21/2019

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