Provider Demographics
NPI:1619108248
Name:FINE, AMY B (DMD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:B
Last Name:FINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:BIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:931 CHEVY WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4127
Mailing Address - Country:US
Mailing Address - Phone:541-535-6239
Mailing Address - Fax:541-512-3178
Practice Address - Street 1:1113 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5201
Practice Address - Country:US
Practice Address - Phone:541-532-6239
Practice Address - Fax:541-512-1026
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist