=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609683457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY J. DOVER, DDS, MS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11030 S TRYON ST STE 303
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28273-6545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-562-2453
-----------------------------------------------------
Fax | 704-587-6727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11030 S TRYON ST STE 303
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28273-6545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-562-2453
-----------------------------------------------------
Fax | 704-587-6727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AMY DOVER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 704-562-2453
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------