Provider Demographics
NPI:1437587821
Name:AMANDA MCPHERSON, DDS, MS, PA
Entity Type:Organization
Organization Name:AMANDA MCPHERSON, DDS, MS, PA
Other - Org Name:SEVERN RIVER DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:410-647-4094
Mailing Address - Street 1:815 RITCHIE HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4118
Mailing Address - Country:US
Mailing Address - Phone:410-647-4094
Mailing Address - Fax:410-647-9324
Practice Address - Street 1:815 RITCHIE HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4118
Practice Address - Country:US
Practice Address - Phone:410-647-4094
Practice Address - Fax:410-647-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14819335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier