Provider Demographics
NPI:1962774869
Name:AMANDA M. TINKLE DMD PS
Entity type:Organization
Organization Name:AMANDA M. TINKLE DMD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARGAUX
Authorized Official - Last Name:TINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-348-7396
Mailing Address - Street 1:117 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2229
Mailing Address - Country:US
Mailing Address - Phone:360-694-7931
Mailing Address - Fax:360-694-0722
Practice Address - Street 1:117 E 39TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2229
Practice Address - Country:US
Practice Address - Phone:360-694-7931
Practice Address - Fax:360-694-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602665901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty