Provider Demographics
NPI:1427518018
Name:WARD, AMANDA (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:WARD
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 1:1097 WESTON DR
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3493
Mailing Address - Country:US
Mailing Address - Phone:615-758-7745
Mailing Address - Fax:
Practice Address - Street 1:1097 WESTON DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3493
Practice Address - Country:US
Practice Address - Phone:615-758-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24205122300000X
TN11630122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist