Provider Demographics
NPI:1336762624
Name:ARCHANGEL DAVIS, AMANDA (RDH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ARCHANGEL DAVIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3131
Mailing Address - Country:US
Mailing Address - Phone:610-252-8966
Mailing Address - Fax:
Practice Address - Street 1:1625 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3131
Practice Address - Country:US
Practice Address - Phone:610-252-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist