Provider Demographics
NPI:1154497352
Name:AMOS, EDWARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:AMOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3323
Mailing Address - Country:US
Mailing Address - Phone:540-667-8287
Mailing Address - Fax:
Practice Address - Street 1:1002 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3323
Practice Address - Country:US
Practice Address - Phone:540-667-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380000801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA180707OtherANTHEM
WV000464722OtherMOUNTAIN STATE BCBS
VA180707OtherANTHEM