Provider Demographics
NPI:1174551972
Name:HUANG, AMANDA JIE (DMD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JIE
Last Name:HUANG
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 1:3002 SHOREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3183
Mailing Address - Country:US
Mailing Address - Phone:206-552-1952
Mailing Address - Fax:253-839-4046
Practice Address - Street 1:1706 S 320TH ST STE E
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5424
Practice Address - Country:US
Practice Address - Phone:253-839-4048
Practice Address - Fax:253-839-4046
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE-60262499122300000X
WADE602624991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist