Individual
DR. AMANDA SARA BOUSTANY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S., M.S.D.
Contact information
Practice address
405 CAPITOL ST, SUITE 914, CHARLESTON, WV 25301-1749
(304) 345-1248
(304) 345-1249
Mailing address
405 CAPITOL ST, SUITE 914, CHARLESTON, WV 25301-1749
(304) 345-1248
(304) 345-1249
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
4180
WV
Other
Enumeration date
06/25/2013
Last updated
01/05/2017
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