Provider Demographics
NPI:1790866606
Name:AMENDOLA, RICHARD FRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRED
Last Name:AMENDOLA
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 1:1197 N LAKE DR
Mailing Address - Street 2:B
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7645
Mailing Address - Country:US
Mailing Address - Phone:803-359-6130
Mailing Address - Fax:803-359-4218
Practice Address - Street 1:1197 N LAKE DR
Practice Address - Street 2:B
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7645
Practice Address - Country:US
Practice Address - Phone:803-359-6130
Practice Address - Fax:803-359-4218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice