Provider Demographics
NPI:1316529340
Name:BARRETT, AMANDA MARIE (DMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:BARRETT
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 1:1485 PUTNAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-8255
Mailing Address - Country:US
Mailing Address - Phone:843-446-2234
Mailing Address - Fax:
Practice Address - Street 1:1135 MUHLENBERGIA DR STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8405
Practice Address - Country:US
Practice Address - Phone:843-654-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.10115.GD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty