Provider Demographics
NPI:1871102871
Name:PILLAI, AMANDA BEAUCHAMP (DMD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BEAUCHAMP
Last Name:PILLAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MARQUETTE AVE APT 2005
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2922
Mailing Address - Country:US
Mailing Address - Phone:366-692-5964
Mailing Address - Fax:
Practice Address - Street 1:2096 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1813
Practice Address - Country:US
Practice Address - Phone:651-237-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-26
Last Update Date:2020-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND144551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice