Provider Demographics
NPI:1659094621
Name:HANSEN, AMANDA CHURCH (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CHURCH
Last Name:HANSEN
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 1:112 ARUNDEL LN
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-7338
Mailing Address - Country:US
Mailing Address - Phone:302-561-4666
Mailing Address - Fax:
Practice Address - Street 1:385 STARR RD STE 202
Practice Address - Street 2:
Practice Address - City:LANDENBERG
Practice Address - State:PA
Practice Address - Zip Code:19350-9223
Practice Address - Country:US
Practice Address - Phone:610-268-2040
Practice Address - Fax:610-268-2061
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0438981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice