Provider Demographics
NPI:1518087071
Name:DUMOFF, AMANDA JENNIFER (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JENNIFER
Last Name:DUMOFF
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 1:2709 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2303
Mailing Address - Country:US
Mailing Address - Phone:607-624-5761
Mailing Address - Fax:
Practice Address - Street 1:800 RIVER RD
Practice Address - Street 2:#313
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-7237
Practice Address - Country:US
Practice Address - Phone:607-724-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0529551223G0001X
NJ22DI02503700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice