Individual
AMANDA MARIE DUTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
1370 CHORRO ST, SAN LUIS OBISPO, CA 93401
(805) 543-6535
Mailing address
753 CORBETT CYN RD, ARROYO GRANDE, CA 93420
(805) 710-4272
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
57717
CA
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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