Provider Demographics
NPI:1891364238
Name:SANT AMOUR, AMANDA (DDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SANT AMOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 BLONDEAU ST STE 1
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-5657
Mailing Address - Country:US
Mailing Address - Phone:319-768-5849
Mailing Address - Fax:
Practice Address - Street 1:1706 W AGENCY RD
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1667
Practice Address - Country:US
Practice Address - Phone:319-768-5849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist