Provider Demographics
NPI:1770293706
Name:AMANDA SPRINGER DDS PLLC
Entity type:Organization
Organization Name:AMANDA SPRINGER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-776-2223
Mailing Address - Street 1:5376 BIG TYLER RD
Mailing Address - Street 2:
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1059
Mailing Address - Country:US
Mailing Address - Phone:304-776-2223
Mailing Address - Fax:304-776-2223
Practice Address - Street 1:5376 BIG TYLER RD
Practice Address - Street 2:
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1059
Practice Address - Country:US
Practice Address - Phone:304-776-2223
Practice Address - Fax:304-776-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1689103780Medicaid