MEDICARE: AMADOR FAMILY DENTISTRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1548923501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMADOR FAMILY DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	1542 E BAYVIEW BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-3255
Country	:	US
Telephone Number	:	757-690-9369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 E BAYVIEW BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-3255
Country	:	US
Telephone Number	:	757-690-9369
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA AMADOR
Credential	:	DDS
Telephone Number	:	757-690-9369

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	09/10/2025

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