Amanda C Gilles, DDS
Individual provider Active NPI Dentist · Wayland, IA
NPI 1295080422 · NPPES record last updated Jul 13, 2012
Key facts
- NPI
- 1295080422
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 08925 (IA)
- Practice address
- 209 W 2ND St
Wayland, IA 52654-7622 - Phone
- (319) 256-4065
- NPI assigned
- Jul 13, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08925 | IA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 08925 | IA | Yes |
Addresses
Primary practice location
209 W 2ND St
Wayland, IA 52654-7622
Mailing address
1414 Windham Hill Dr
Riverside, IA 52327-1400
Phone (319) 290-5815
Other providers in Wayland, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.