Provider Demographics
NPI:1285954768
Name:DAILEY, AMBER DAWN (DDS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:DAILEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40540 S TERRACE CIR
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7631
Mailing Address - Country:US
Mailing Address - Phone:406-570-2600
Mailing Address - Fax:
Practice Address - Street 1:7300 N PERIMETER RD
Practice Address - Street 2:
Practice Address - City:MALMSTROM AFB
Practice Address - State:MT
Practice Address - Zip Code:59402-6701
Practice Address - Country:US
Practice Address - Phone:406-570-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist