Provider Demographics
NPI:1679169916
Name:AMANDA M. SMITH, LLC
Entity type:Organization
Organization Name:AMANDA M. SMITH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:603-880-3000
Mailing Address - Street 1:1 TRAFALGAR SQ STE 103
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1998
Mailing Address - Country:US
Mailing Address - Phone:603-880-3000
Mailing Address - Fax:
Practice Address - Street 1:1 TRAFALGAR SQ STE 103
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1998
Practice Address - Country:US
Practice Address - Phone:603-880-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental