Provider Demographics
NPI:1033420567
Name:SCHWADERER, AMANDA JEAN (DDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:SCHWADERER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1819
Mailing Address - Country:US
Mailing Address - Phone:605-763-5035
Mailing Address - Fax:605-763-8036
Practice Address - Street 1:116 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-1819
Practice Address - Country:US
Practice Address - Phone:605-763-5035
Practice Address - Fax:605-763-8036
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist