Provider Demographics
NPI:1790163277
Name:MILLER, AMANDA LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:HUPFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-1100
Mailing Address - Country:US
Mailing Address - Phone:517-741-4565
Mailing Address - Fax:517-741-8912
Practice Address - Street 1:715 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:MI
Practice Address - Zip Code:49094-1100
Practice Address - Country:US
Practice Address - Phone:517-741-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010215401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice