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General NPI Number Information
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NPI Number | 1346613056
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Entity Type | Organization
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Legal Business Name | AMISON DDS LLC
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 3431 COMMERCE PKWY
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City | WOOSTER
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State | OH
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Zip | 44691-7114
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Country | US
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Telephone | 330-264-8973
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Fax |
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Provider Business Mailing Address
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Address Line | 1172 CORSHAM CIR
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City | AKRON
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State | OH
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Zip | 44312-5906
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Country | US
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Telephone | 330-388-8243
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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. BRIAN AMISON
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Credential | DDS
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Telephone | 330-388-8243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 017218
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 023452
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License Number State | OH
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