Provider Demographics
NPI:1447331236
Name:DENOMME-STOUGH, AMANDA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNN
Last Name:DENOMME-STOUGH
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 1:591 W CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9189
Mailing Address - Country:US
Mailing Address - Phone:517-279-7900
Mailing Address - Fax:517-279-7914
Practice Address - Street 1:591 W CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-9189
Practice Address - Country:US
Practice Address - Phone:517-279-7900
Practice Address - Fax:517-279-7914
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010194181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901019418OtherDENTIST LICENSE