Provider Demographics
NPI:1639511298
Name:COYLE, AMANDA DANIELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:DANIELLE
Last Name:COYLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 STERLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1430
Mailing Address - Country:US
Mailing Address - Phone:618-977-8677
Mailing Address - Fax:
Practice Address - Street 1:16100 CHESTERFIELD PKWY W
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4871
Practice Address - Country:US
Practice Address - Phone:636-532-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013021037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist