Provider Demographics
NPI:1184006181
Name:HYLAND, AMANDA LEE ECKHARDT (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEE ECKHARDT
Last Name:HYLAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12783 460TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013-7618
Mailing Address - Country:US
Mailing Address - Phone:507-525-3978
Mailing Address - Fax:
Practice Address - Street 1:601 MCHUGH RD
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9579
Practice Address - Country:US
Practice Address - Phone:608-526-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-25
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001152-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist