Provider Demographics
NPI:1285251975
Name:ST. HILAIRE, AMENDA (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:AMENDA
Middle Name:
Last Name:ST. HILAIRE
Suffix:
Gender:F
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25590 PROSPECT AVE APT 11A
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3145
Mailing Address - Country:US
Mailing Address - Phone:954-914-3538
Mailing Address - Fax:
Practice Address - Street 1:2817 W LOOP 250 N STE B
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3205
Practice Address - Country:US
Practice Address - Phone:432-694-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX36368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program