Healthcare Provider Details

I. General information

NPI: 1205268257
Provider Name (Legal Business Name): ROBERT WILLIAM AMOS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 ROSE HILL DR DENTAL SUITE
CHARLOTTESVILLE VA
22903-5128
US

IV. Provider business mailing address

1800 JEFFERSON PARK AVE CONDO #12
CHARLOTTESVILLE VA
22903-3554
US

V. Phone/Fax

Practice location:
  • Phone: 434-982-6215
  • Fax:
Mailing address:
  • Phone: 540-539-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0401414008
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: