Provider Demographics
NPI:1962701748
Name:DAY, AMANDA ELSPETH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELSPETH
Last Name:DAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELSPETH
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11102 SE CAUSEY CIR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4709
Mailing Address - Country:US
Mailing Address - Phone:615-497-9846
Mailing Address - Fax:
Practice Address - Street 1:1105 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2810
Practice Address - Country:US
Practice Address - Phone:503-363-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-20
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD99631223P0221X, 122300000X
IL019.029546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist