Healthcare Provider Details

I. General information

NPI: 1548923501
Provider Name (Legal Business Name): AMADOR FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 E BAYVIEW BLVD
NORFOLK VA
23503-3255
US

IV. Provider business mailing address

1542 E BAYVIEW BLVD
NORFOLK VA
23503-3255
US

V. Phone/Fax

Practice location:
  • Phone: 757-690-9369
  • Fax:
Mailing address:
  • Phone: 757-690-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARIA AMADOR
Title or Position: OWNER
Credential: DDS
Phone: 757-690-9369