MEDICARE: ROXZANNE J AMOS DMD

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	1223G0001X	General Practice Dentistry	0401410815	VA
2	122300000X	Dentist	0401410815	VA

General Provider Information

NPI Number	:	1871772640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXZANNE J AMOS DMD

Provider Business Mailing Address
First Line	:	1432 N GREAT NECK RD STE 104
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1342
Country	:	US
Telephone Number	:	757-486-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 N GREAT NECK RD STE 104
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-1342
Country	:	US
Telephone Number	:	757-486-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	05/10/2022

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