Provider Demographics
NPI:1639502354
Name:KNESTRICK, AMANDA SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SUE
Last Name:KNESTRICK
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 1:27 CLEAR SPRING DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-3202
Mailing Address - Country:US
Mailing Address - Phone:304-619-4343
Mailing Address - Fax:
Practice Address - Street 1:27 CLEAR SPRING DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-3202
Practice Address - Country:US
Practice Address - Phone:304-619-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice