Provider Demographics
NPI:1871907956
Name:MCCAULEY, AMANDA KOEPPEL (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KOEPPEL
Last Name:MCCAULEY
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 1:18323 98TH AVE NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18323 98TH AVE NE
Practice Address - Street 2:SUITE 2
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3358
Practice Address - Country:US
Practice Address - Phone:804-304-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604605121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice