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General NPI Number Information
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NPI Number | 1942835822
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Entity Type | Individual
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Provider Name | AMANDA VEDROS DDS
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Gender | Female
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1013 UNIVERSITY BLVD
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City | SUFFOLK
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State | VA
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Zip | 23435-3900
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Country | US
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Telephone | 757-956-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 1086 KINGSTON LN
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City | NORTH
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State | VA
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Zip | 23128-2011
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Country | US
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Telephone | 757-416-4702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401416993
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License Number State | VA
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