Provider Demographics
NPI:1285424606
Name:MIZERA, AMANDA LEE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEE
Last Name:MIZERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 BANTON RD
Mailing Address - Street 2:
Mailing Address - City:PALERMO
Mailing Address - State:ME
Mailing Address - Zip Code:04354-6529
Mailing Address - Country:US
Mailing Address - Phone:207-242-5363
Mailing Address - Fax:
Practice Address - Street 1:1 VA CTR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6795
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant