Provider Demographics
NPI:1710542196
Name:GRIEGO, AMANDA CHRISTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:GRIEGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MANDY
Other - Middle Name:C
Other - Last Name:GRIEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:905 LOS PINOS WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1850
Mailing Address - Country:US
Mailing Address - Phone:915-526-9861
Mailing Address - Fax:
Practice Address - Street 1:1050 SUNLAND PARK DR # B200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1326
Practice Address - Country:US
Practice Address - Phone:915-213-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice