Individual
AMANDA ELIZABETH GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
8778
KY
1223P0221X
Pediatric Dentistry
Primary
8778
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100123440
—
KY
Enumeration date
05/13/2009
Last updated
02/08/2016
Update your record
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