Provider Demographics
NPI:1093168791
Name:AMANDA MCCAULEY DDS
Entity Type:Organization
Organization Name:AMANDA MCCAULEY DDS
Other - Org Name:MCCAULEY FAMILY AND COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:KOEPPEL
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-354-3138
Mailing Address - Street 1:18323 98TH AVE NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3358
Mailing Address - Country:US
Mailing Address - Phone:425-354-3138
Mailing Address - Fax:425-998-9334
Practice Address - Street 1:18323 98TH AVE NE
Practice Address - Street 2:SUITE 2
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3358
Practice Address - Country:US
Practice Address - Phone:425-354-3138
Practice Address - Fax:425-998-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60460512261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental