Provider Demographics
NPI:1043538846
Name:HILLIS, AMANDA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:HILLIS
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 1:1173 REELFOOT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2934
Mailing Address - Country:US
Mailing Address - Phone:701-226-6840
Mailing Address - Fax:
Practice Address - Street 1:7421 MEXICO RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1369
Practice Address - Country:US
Practice Address - Phone:636-970-7902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010012887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist