Provider Demographics
NPI:1265074629
Name:RODMAN, AMANDA RACHEL (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:RACHEL
Last Name:RODMAN
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 1:5500 N MILITARY TRL APT 444
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3569
Mailing Address - Country:US
Mailing Address - Phone:410-980-0028
Mailing Address - Fax:
Practice Address - Street 1:224 CHIMNEY CORNER LN APT 3022
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4802
Practice Address - Country:US
Practice Address - Phone:561-404-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL245091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice