Provider Demographics
NPI:1861689887
Name:HALLINAN, AMANDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:HALLINAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WIEGAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:37 LEGACY DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2374
Mailing Address - Country:US
Mailing Address - Phone:617-733-9634
Mailing Address - Fax:
Practice Address - Street 1:31 LOWELL RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1857
Practice Address - Country:US
Practice Address - Phone:603-898-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist