Provider Demographics
NPI:1235693706
Name:ASIAMAH, VIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIDA
Middle Name:
Last Name:ASIAMAH
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 1:43768 CENTRAL STATION DR APT 511
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7393
Mailing Address - Country:US
Mailing Address - Phone:917-702-6306
Mailing Address - Fax:
Practice Address - Street 1:14679 APPLE HARVEST DR STE 100
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3703
Practice Address - Country:US
Practice Address - Phone:304-596-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416398122300000X
WI6001142-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist