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General NPI Number Information
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NPI Number | 1992471288
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE AMISON, DDS, LLC
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 6533 BRECKSVILLE RD A
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City | INDEPENDENCE
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State | OH
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Zip | 44131
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Country | US
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Telephone | 216-524-7275
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Fax |
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Provider Business Mailing Address
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Address Line | 1172 CORSHAM CIRCLE
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City | AKRON
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State | OH
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Zip | 44312
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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 | BRIAN LAMAR 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 |
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License Number State |
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