Active NPI
Amanda R. Medina, DENTAL ASSISTANT
- Dental Assistant
- Dayton, OH
National Provider Identifier
1861629099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 00845
- Practice address
- 1 Childrens PLZ
Suite 2070
Dayton, OH 45404-1898 - Phone
- (937) 641-3455
- NPI assigned
- Jun 15, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 00845 | OH | |
| Dental Assistant | 126800000X | 00845 | OH | Primary |
Addresses
Primary practice location
1 Childrens PLZ
Suite 2070
Dayton, OH 45404-1898
Mailing address
725 Patterson Rd
Apartment #2
Dayton, OH 45419-4319
Phone (937) 344-4291
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00845 | OH | MD | Dental Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hensley Pediatric Dentistry, Inc. | Pediatric Dentistry | Past | Accepting new patients |
| Womack Dayton Pediatric Dentistry Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Dayton, OH
- NPI 1447496476
-
- Dentist
- Dayton, OH
- NPI 1710032305
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245024000000",
"number": "1861629099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 PATTERSON RD",
"address_2": "APARTMENT #2",
"city": "DAYTON",
"state": "OH",
"postal_code": "454194319",
"telephone_number": "937-344-4291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CHILDRENS PLZ",
"address_2": "SUITE 2070",
"city": "DAYTON",
"state": "OH",
"postal_code": "454041898",
"telephone_number": "937-641-3455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "AMANDA",
"middle_name": "R.",
"name_prefix": "Miss",
"credential": "DENTAL ASSISTANT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-15",
"last_updated": "2009-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OH",
"license": "00845",
"primary": false
},
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "OH",
"license": "00845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.