Provider Demographics
NPI:1477936243
Name:SONNTAG, AMANDA STEGEMAN (DDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:STEGEMAN
Last Name:SONNTAG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BROGAN
Other - Last Name:STEGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1286 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2130
Mailing Address - Country:US
Mailing Address - Phone:610-816-6306
Mailing Address - Fax:610-372-3998
Practice Address - Street 1:1286 PENN AVE
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2130
Practice Address - Country:US
Practice Address - Phone:610-816-6306
Practice Address - Fax:610-372-3998
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist