Provider Demographics
NPI:1891911723
Name:BOURFF, AMANDA GREENLEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:GREENLEE
Last Name:BOURFF
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 1:55 BRENDON WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1955
Mailing Address - Country:US
Mailing Address - Phone:317-873-6750
Mailing Address - Fax:317-873-6708
Practice Address - Street 1:55 BRENDON WAY STE 200
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1955
Practice Address - Country:US
Practice Address - Phone:317-873-6750
Practice Address - Fax:317-873-6708
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010671A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist