Provider Demographics
NPI:1518257161
Name:MATTHEWS, AMANDA BAYLEY (DMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BAYLEY
Last Name:MATTHEWS
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 1:2605 KIMBROUGH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-1404
Mailing Address - Country:US
Mailing Address - Phone:302-766-4632
Mailing Address - Fax:
Practice Address - Street 1:900 FOULK RD STE 203
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3155
Practice Address - Country:US
Practice Address - Phone:302-797-1212
Practice Address - Fax:302-797-1211
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00013141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice