Provider Demographics
NPI:1689701740
Name:STEWART, AMANDA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:NICOLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:ESTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6912 SE VANDALIA DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-5164
Mailing Address - Country:US
Mailing Address - Phone:515-864-1871
Mailing Address - Fax:
Practice Address - Street 1:907 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4002
Practice Address - Country:US
Practice Address - Phone:515-964-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190270981223G0001X
IA085961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice