Provider Demographics
NPI:1497325633
Name:MCKANE, AMANDA N (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:N
Last Name:MCKANE
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 1:14628 MORNINGSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7411
Mailing Address - Country:US
Mailing Address - Phone:708-921-6927
Mailing Address - Fax:
Practice Address - Street 1:12721 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-2178
Practice Address - Country:US
Practice Address - Phone:708-448-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0332811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice