1053373092 NPI number — THEODORE AMEREDES DDS

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053373092 NPI number — THEODORE AMEREDES DDS

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

AMEREDES

Provider First Name:

THEODORE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

DDS

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1053373092

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/14/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1433 OVERLOOK DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WEIRTON

Provider Business Mailing Address State Name:

WV

Provider Business Mailing Address Postal Code:

26062-5126

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

412-680-0366

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1433 OVERLOOK DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WEIRTON

Provider Business Practice Location Address State Name:

WV

Provider Business Practice Location Address Postal Code:

26062-5126

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

412-680-0366

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 122300000X , with the licence number:  DS036716 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1015259710003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1015259710001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".