Provider Demographics
NPI:1184837452
Name:AMIGO, JOSEPHINE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:A
Last Name:AMIGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5461
Mailing Address - Country:US
Mailing Address - Phone:301-777-7700
Mailing Address - Fax:301-777-7710
Practice Address - Street 1:115 MARKET ST
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5461
Practice Address - Country:US
Practice Address - Phone:301-777-7700
Practice Address - Fax:301-777-7710
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry