MEDICARE: DR. PAMELA S AMUNDSON 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
1	1223P0300X	Periodontics	30-02-0345	OH

General Provider Information

NPI Number	:	1922189851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA S AMUNDSON DDS

Provider Business Mailing Address
First Line	:	3948 PINE LAKE CIR
Second Line	:
City	:	RICHFIELD
State	:	OH
Zip	:	44286-9570
Country	:	US
Telephone Number	:	440-668-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 N CLEVELAND MASSILLON RD STE 105
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-3332
Country	:	US
Telephone Number	:	330-666-6111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/10/2019

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