Provider Demographics
NPI:1780108209
Name:AMANDA L. HYLAND D.D.S. P.A
Entity type:Organization
Organization Name:AMANDA L. HYLAND D.D.S. P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LE
Authorized Official - Last Name:HYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-387-3249
Mailing Address - Street 1:111 STAR ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4889
Mailing Address - Country:US
Mailing Address - Phone:507-387-3249
Mailing Address - Fax:
Practice Address - Street 1:810 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7767
Practice Address - Country:US
Practice Address - Phone:507-387-3249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental