Provider Demographics
NPI:1134472822
Name:WAMPLER, CYNTHIA P (RDH, MS)
Entity Type:Individual
Prefix:PROF
First Name:CYNTHIA
Middle Name:P
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 OLEANDER CT
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-3630
Mailing Address - Country:US
Mailing Address - Phone:904-249-4166
Mailing Address - Fax:
Practice Address - Street 1:607 OLEANDER CT
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-3630
Practice Address - Country:US
Practice Address - Phone:904-249-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH5804124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist