Provider Demographics
NPI:1245030139
Name:SMITH, AMANDA L (RDH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOGELAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3326
Mailing Address - Country:US
Mailing Address - Phone:267-496-2739
Mailing Address - Fax:
Practice Address - Street 1:508 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5512
Practice Address - Country:US
Practice Address - Phone:215-860-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH068921124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist