Provider Demographics
NPI:1316372691
Name:SCHWARTZ, AMANDA GRAYCE (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:GRAYCE
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 BELKNAP ST
Mailing Address - Street 2:STE. 220
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2960
Mailing Address - Country:US
Mailing Address - Phone:715-392-4545
Mailing Address - Fax:
Practice Address - Street 1:823 BELKNAP ST
Practice Address - Street 2:STE. 220
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2960
Practice Address - Country:US
Practice Address - Phone:715-392-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7162-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist