Provider Demographics
NPI:1689093148
Name:AUGUSTINE, AMY ELISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELISE
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-1260
Mailing Address - Country:US
Mailing Address - Phone:419-592-9956
Mailing Address - Fax:419-592-9855
Practice Address - Street 1:875 WESTMORELAND AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1260
Practice Address - Country:US
Practice Address - Phone:419-592-9956
Practice Address - Fax:419-592-9855
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0249461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry