Provider Demographics
NPI:1669853305
Name:MERIKAS, AMANDA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:MERIKAS
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 1:142 BIGELOW ST
Mailing Address - Street 2:UNIT #102
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1738
Mailing Address - Country:US
Mailing Address - Phone:847-529-1531
Mailing Address - Fax:
Practice Address - Street 1:2797 NE 207TH ST
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1471
Practice Address - Country:US
Practice Address - Phone:786-707-4308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist