Provider Demographics
NPI:1952195588
Name:MORRILL, AMANDA M (RDH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:MORRILL
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARY
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1058
Mailing Address - Country:US
Mailing Address - Phone:262-620-6997
Mailing Address - Fax:
Practice Address - Street 1:500 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1058
Practice Address - Country:US
Practice Address - Phone:262-620-6997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5989-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist