Provider Demographics
NPI:1043701899
Name:AMOR, BRITTANY LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:LEIGH
Last Name:AMOR
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 1:2095 W FRYE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6280
Mailing Address - Country:US
Mailing Address - Phone:480-917-8400
Mailing Address - Fax:
Practice Address - Street 1:2095 W FRYE RD STE 4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6280
Practice Address - Country:US
Practice Address - Phone:480-917-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010139122300000X
MI29010225721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043701899Medicaid