Provider Demographics
NPI:1942598040
Name:CASWELL-BURT, AMANDA G (DDS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:CASWELL-BURT
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:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0074
Mailing Address - Country:US
Mailing Address - Phone:208-597-7800
Mailing Address - Fax:877-871-1382
Practice Address - Street 1:1212 N. DIVISION AVE.
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-597-7800
Practice Address - Fax:877-871-1382
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDD-4371-PD1223P0221X
IDD43711223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist