Provider Demographics
NPI:1245026137
Name:AMANDA PUUSTINEN DMD PA
Entity type:Organization
Organization Name:AMANDA PUUSTINEN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUUSTINEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-689-7687
Mailing Address - Street 1:2506 W CLEVELAND ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3689
Mailing Address - Country:US
Mailing Address - Phone:386-689-7687
Mailing Address - Fax:
Practice Address - Street 1:10225 ULMERTON RD STE 4C
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3520
Practice Address - Country:US
Practice Address - Phone:386-689-7687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental