Healthcare Provider Details

I. General information

NPI: 1326622887
Provider Name (Legal Business Name): MELISSA S AMUNDSON DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N CENTER ST
PERRY FL
32347-2038
US

IV. Provider business mailing address

520 PLANTATION RD
TALLAHASSEE FL
32303-4208
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-4613
  • Fax:
Mailing address:
  • Phone: 847-721-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MELISSA AMUNDSON
Title or Position: OWNER/SURGEON
Credential: DDS
Phone: 850-584-4613