Provider Demographics
NPI:1407500077
Name:RANKIN, AMY S (RDH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:RANKIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 NELSON MAINE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3106
Mailing Address - Country:US
Mailing Address - Phone:757-238-9856
Mailing Address - Fax:
Practice Address - Street 1:46 NELSON MAINE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3106
Practice Address - Country:US
Practice Address - Phone:757-238-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402002710124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist