Provider Demographics
NPI:1922189851
Name:AMUNDSON, PAMELA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 PINE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9570
Mailing Address - Country:US
Mailing Address - Phone:440-668-6109
Mailing Address - Fax:
Practice Address - Street 1:525 N CLEVELAND MASSILLON RD STE 105
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-3332
Practice Address - Country:US
Practice Address - Phone:330-666-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-03451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics