Provider Demographics
NPI:1639386394
Name:ROEDER, AMY MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
Last Name:ROEDER
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 1:5028 HANNAH DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3870
Mailing Address - Country:US
Mailing Address - Phone:615-414-5994
Mailing Address - Fax:
Practice Address - Street 1:2805 OLD FORT PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5115
Practice Address - Country:US
Practice Address - Phone:615-414-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry