Provider Demographics
NPI:1306842653
Name:AMISON, BRIAN LAMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LAMAR
Last Name:AMISON
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 1:2223 FULTON RD NW
Mailing Address - Street 2:STE 201
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3554
Mailing Address - Country:US
Mailing Address - Phone:330-452-2255
Mailing Address - Fax:330-452-2293
Practice Address - Street 1:2223 FULTON RD NW
Practice Address - Street 2:STE 201
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3554
Practice Address - Country:US
Practice Address - Phone:330-452-2255
Practice Address - Fax:330-452-2293
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist