Provider Demographics
NPI:1588830483
Name:AMANDA J. DARLING, D.D.S., P.C.
Entity Type:Organization
Organization Name:AMANDA J. DARLING, D.D.S., P.C.
Other - Org Name:LEGACY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-227-8400
Mailing Address - Street 1:485 WILDWOOD PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2667
Mailing Address - Country:US
Mailing Address - Phone:636-227-8400
Mailing Address - Fax:636-227-8403
Practice Address - Street 1:485 WILDWOOD PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2667
Practice Address - Country:US
Practice Address - Phone:636-227-8400
Practice Address - Fax:636-227-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080058531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty