Provider Demographics
NPI:1922393750
Name:EIDELSON, AMANDA BLAIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BLAIR
Last Name:EIDELSON
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 1:303 KINGS HWY S STE 6
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2579
Mailing Address - Country:US
Mailing Address - Phone:856-429-7811
Mailing Address - Fax:856-429-7811
Practice Address - Street 1:303 KINGS HWY S STE 6
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2579
Practice Address - Country:US
Practice Address - Phone:856-429-7811
Practice Address - Fax:856-429-7819
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025263001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics