Provider Demographics
NPI:1720786841
Name:DOSS, AMANDA (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:DOSS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 CRESTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-4838
Mailing Address - Country:US
Mailing Address - Phone:805-266-5993
Mailing Address - Fax:
Practice Address - Street 1:4825 CRESTWOOD CT
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-4838
Practice Address - Country:US
Practice Address - Phone:805-266-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27227124Q00000X
CA602125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125K00000XDental ProvidersAdvanced Practice Dental Therapist
No124Q00000XDental ProvidersDental Hygienist