Provider Demographics
NPI:1285075135
Name:DYER, AMANDA NICHOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:NICHOLE
Last Name:DYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SAVANNAH CIR
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1637
Mailing Address - Country:US
Mailing Address - Phone:319-215-5876
Mailing Address - Fax:
Practice Address - Street 1:1600 SAVANNAH CIR
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1637
Practice Address - Country:US
Practice Address - Phone:319-215-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0319251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice