Provider Demographics
NPI:1962165993
Name:WOODS, AMANDA MARY (RDH, MFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARY
Last Name:WOODS
Suffix:
Gender:F
Credentials:RDH, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-5913
Mailing Address - Country:US
Mailing Address - Phone:802-922-0960
Mailing Address - Fax:
Practice Address - Street 1:49 CLOVER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-5913
Practice Address - Country:US
Practice Address - Phone:802-922-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT022706124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist