Provider Demographics
NPI:1891854832
Name:ALLEN, AMANDA BUNTZMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BUNTZMAN
Last Name:ALLEN
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 1:3328 48TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5882
Mailing Address - Country:US
Mailing Address - Phone:507-285-0321
Mailing Address - Fax:
Practice Address - Street 1:40 W NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4524
Practice Address - Country:US
Practice Address - Phone:952-926-3892
Practice Address - Fax:952-891-0226
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND118771223P0221X
KY78591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV04918Medicare UPIN