Provider Demographics
NPI:1306523816
Name:EUDY, AMANDA JO (DDS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:EUDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 JOHN F KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3810
Mailing Address - Country:US
Mailing Address - Phone:563-556-4234
Mailing Address - Fax:563-556-0597
Practice Address - Street 1:1890 JOHN F KENNEDY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3810
Practice Address - Country:US
Practice Address - Phone:563-556-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS10136122300000X
IADDS-10136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty