Provider Demographics
NPI:1831330737
Name:DINWIDDIE, AMELIA JO (DDS)
Entity type:Individual
Prefix:MISS
First Name:AMELIA
Middle Name:JO
Last Name:DINWIDDIE
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-0087
Mailing Address - Country:US
Mailing Address - Phone:731-584-7874
Mailing Address - Fax:731-584-9554
Practice Address - Street 1:116 VICKSBURG AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1614
Practice Address - Country:US
Practice Address - Phone:731-584-7874
Practice Address - Fax:731-584-9554
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice