Provider Demographics
NPI:1689103780
Name:SPRINGER, AMANDA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:M
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:SPRINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5376 BIG TYLER RD
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1059
Mailing Address - Country:US
Mailing Address - Phone:304-776-2223
Mailing Address - Fax:304-776-2225
Practice Address - Street 1:5376 BIG TYLER RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1059
Practice Address - Country:US
Practice Address - Phone:304-776-2223
Practice Address - Fax:304-776-2225
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV42671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice