Provider Demographics
NPI:1457788655
Name:GARRISON, AMANDA LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:GARRISON
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 1:1008 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-1522
Mailing Address - Country:US
Mailing Address - Phone:513-367-4441
Mailing Address - Fax:
Practice Address - Street 1:1008 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1522
Practice Address - Country:US
Practice Address - Phone:513-367-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH237341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice