Provider Demographics
NPI:1922412816
Name:SMITH, AMANDA (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TRAFALGAR SQ STE 103
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1998
Mailing Address - Country:US
Mailing Address - Phone:603-880-3000
Mailing Address - Fax:
Practice Address - Street 1:1 TRAFALGAR SQ STE 103
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1998
Practice Address - Country:US
Practice Address - Phone:603-880-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH04055OtherNH DENTAL LICENSE NUMBER