Provider Demographics
NPI:1255744926
Name:CARDINALE, AMANDA ASHLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ASHLEY
Last Name:CARDINALE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:ASHLEY
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:110 BRIDGE ST.
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-329-7600
Mailing Address - Fax:
Practice Address - Street 1:110 BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-329-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856563122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist