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NPI Code Detail

MEDICARE: DR. RICHARD FRED AMENDOLA DDS

MEDICARE:  DR. RICHARD FRED AMENDOLA  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry3856SC

General Provider Information

NPI Number : 1790866606
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD FRED AMENDOLA DDS
Provider Business Mailing Address
First Line : 1197 N LAKE DR
Second Line : B
City : LEXINGTON
State : SC
Zip : 29072-7645
Country : US
Telephone Number : 803-359-6130
Fax Number : 803-359-4218
Provider Business Practice Location Address
First Line : 1197 N LAKE DR
Second Line : B
City : LEXINGTON
State : SC
Zip : 29072-7645
Country : US
Telephone Number : 803-359-6130
Fax Number : 803-359-4218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 07/08/2007

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Directions to “ DR. RICHARD FRED AMENDOLA DDS” Practice Location

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