Provider Demographics
NPI:1134359433
Name:FITZPATRICK, AMANDA LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEIGH
Last Name:FITZPATRICK
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 1:119 W SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MO
Mailing Address - Zip Code:63549-1166
Mailing Address - Country:US
Mailing Address - Phone:660-332-4969
Mailing Address - Fax:660-332-4269
Practice Address - Street 1:119 W SANDERS ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MO
Practice Address - Zip Code:63549-1166
Practice Address - Country:US
Practice Address - Phone:660-332-4969
Practice Address - Fax:660-332-4269
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090159341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice