Provider Demographics
NPI:1295080422
Name:GILLES, AMANDA C (DDS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:C
Last Name:GILLES
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 1:1414 WINDHAM HILL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IA
Mailing Address - Zip Code:52327-1400
Mailing Address - Country:US
Mailing Address - Phone:319-290-5815
Mailing Address - Fax:
Practice Address - Street 1:209 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:IA
Practice Address - Zip Code:52654-7622
Practice Address - Country:US
Practice Address - Phone:319-256-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist