Provider Demographics
NPI:1720286727
Name:EWING, AMANDA (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:EWING
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 FALSE RIVER DR. STE C
Mailing Address - Street 2:
Mailing Address - City:NEW ROADS
Mailing Address - State:LA
Mailing Address - Zip Code:70760
Mailing Address - Country:US
Mailing Address - Phone:225-638-3384
Mailing Address - Fax:225-208-1009
Practice Address - Street 1:3645 WILLIAMS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3464
Practice Address - Country:US
Practice Address - Phone:504-443-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist