Provider Demographics
NPI:1891015095
Name:STOUGH, AMANDA M (DMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:STOUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 E BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17364-9570
Mailing Address - Country:US
Mailing Address - Phone:717-259-8805
Mailing Address - Fax:
Practice Address - Street 1:340 LUMBER ST STE C
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1668
Practice Address - Country:US
Practice Address - Phone:717-359-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist