Provider Demographics
NPI:1457615668
Name:NEWCITY, AMANDA L (DMD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:NEWCITY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-653-6208
Mailing Address - Fax:813-685-2110
Practice Address - Street 1:313 S LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2815
Practice Address - Country:US
Practice Address - Phone:727-542-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist