Individual
MRS. AMANDA SHAVINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PDHA 1
Contact information
Practice address
829 CHIEF EDDIE HOFFMAN HIGHWAY, BETHEL, AK 99559-0528
(907) 827-8111
(907) 827-8351
Mailing address
PO BOX 86, MEKORYUK, AK 99630-0086
(907) 827-2078
(907) 827-8351
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
11-082-PDHA1
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-082-PDHA1
PDHA 1 CERTIFICATION NUMBER
AK
Enumeration date
12/07/2011
Last updated
12/07/2011
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