Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 10130 | NC |
Y | 1223D0001X | Dental Public Health | 10130 | NC |
NPI | 1548644040 |
---|---|
Provider Name | Dr. Amanda Stroud |
First Address | Jefferson, NC 28640-0208 |
Second Address | Jefferson, NC 28640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2015 |
Last Update Date | 13/12/2018 |