Provider Demographics
NPI:1558649806
Name:VENK, AMANDA POUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:POUND
Last Name:VENK
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 1:500 DRIGGS AVE
Mailing Address - Street 2:GROUND FLOOR SUITE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-9349
Mailing Address - Country:US
Mailing Address - Phone:405-229-2844
Mailing Address - Fax:
Practice Address - Street 1:500 DRIGGS AVE
Practice Address - Street 2:GROUND FLOOR SUITE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211
Practice Address - Country:US
Practice Address - Phone:405-229-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK63041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice