Provider Demographics
NPI:1538414156
Name:DEWEERD, AMBER FAITH (DDS)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:FAITH
Last Name:DEWEERD
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 1:1220 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3006
Mailing Address - Country:US
Mailing Address - Phone:540-450-2100
Mailing Address - Fax:
Practice Address - Street 1:1220 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3006
Practice Address - Country:US
Practice Address - Phone:540-662-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414972122300000X, 1223G0001X
IL0190291491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist