Provider Demographics
NPI:1558444372
Name:JUAREZ, AMANDA KAYLYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAYLYN
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 POST OAK BLVD STE 1620
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3013
Mailing Address - Country:US
Mailing Address - Phone:713-622-6112
Mailing Address - Fax:
Practice Address - Street 1:1300 POST OAK BLVD STE 1620
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3013
Practice Address - Country:US
Practice Address - Phone:713-622-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty