Provider Demographics
NPI:1326409186
Name:BRIAN L. AMISON, DDS, LLC
Entity Type:Organization
Organization Name:BRIAN L. AMISON, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:AMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-452-2255
Mailing Address - Street 1:3684 DRESSLER RD NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2781
Mailing Address - Country:US
Mailing Address - Phone:330-452-2255
Mailing Address - Fax:330-452-2293
Practice Address - Street 1:3684 DRESSLER RD NW
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2781
Practice Address - Country:US
Practice Address - Phone:330-452-2255
Practice Address - Fax:330-452-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty