Provider Demographics
NPI:1134283542
Name:SPINKS, AMY ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANTHONY
Last Name:SPINKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-0511
Mailing Address - Country:US
Mailing Address - Phone:601-657-4326
Mailing Address - Fax:601-657-8867
Practice Address - Street 1:102 WEST FREEDOM DRIVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-0511
Practice Address - Country:US
Practice Address - Phone:601-657-4326
Practice Address - Fax:601-657-8867
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3380-06122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04155296Medicaid