Provider Demographics
NPI:1598967127
Name:VEGA, AMY SARAH (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SARAH
Last Name:VEGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SARAH
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:253 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3111
Mailing Address - Country:US
Mailing Address - Phone:508-697-7102
Mailing Address - Fax:508-697-5102
Practice Address - Street 1:253 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3111
Practice Address - Country:US
Practice Address - Phone:508-697-1440
Practice Address - Fax:508-697-5102
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040235721223G0001X
MA215381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice