Provider Demographics
NPI:1942835822
Name:VEDROS, AMANDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:VEDROS
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 1:1086 KINGSTON LN
Mailing Address - Street 2:
Mailing Address - City:NORTH
Mailing Address - State:VA
Mailing Address - Zip Code:23128-2011
Mailing Address - Country:US
Mailing Address - Phone:757-416-4702
Mailing Address - Fax:
Practice Address - Street 1:1013 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3900
Practice Address - Country:US
Practice Address - Phone:757-956-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014169931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice