Provider Demographics
NPI:1154814028
Name:ZELNICK, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZELNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 1269
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0013
Mailing Address - Country:US
Mailing Address - Phone:314-590-7161
Mailing Address - Fax:
Practice Address - Street 1:GEB 3703
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:DEUTSCHLAND
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0316801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice