Provider Demographics
NPI:1639244494
Name:AMLEY, EDWARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:AMLEY
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 1:5753 FIRST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7913
Mailing Address - Country:US
Mailing Address - Phone:727-381-1062
Mailing Address - Fax:727-343-8337
Practice Address - Street 1:5753 FIRST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7913
Practice Address - Country:US
Practice Address - Phone:727-381-1062
Practice Address - Fax:727-343-8337
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN42331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics