Provider Demographics
NPI:1679943385
Name:TJ AMEREDES, DDS, PLLC
Entity type:Organization
Organization Name:TJ AMEREDES, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AMEREDES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-242-2400
Mailing Address - Street 1:160 KRUGER ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5160
Mailing Address - Country:US
Mailing Address - Phone:304-242-2400
Mailing Address - Fax:304-242-2401
Practice Address - Street 1:160 KRUGER ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5160
Practice Address - Country:US
Practice Address - Phone:304-242-2400
Practice Address - Fax:304-242-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty