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General NPI Number Information
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NPI Number | 1205640307
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Entity Type | Organization
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Legal Business Name | AMYN, LLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 2600 TAYLOR RD
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City | CHESAPEAKE
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State | VA
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Zip | 23321-2206
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Country | US
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Telephone | 757-800-1011
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Fax | 757-800-6040
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Provider Business Mailing Address
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Address Line | 1833 ASHLAR LN
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3431
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Country | US
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Telephone | 304-993-1616
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY NAMSUPAK
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Credential | DDS
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Telephone | 757-800-1011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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