Theodore Ameredes, DDS
Individual provider Active NPI Dentist · Weirton, WV
NPI 1053373092 · NPPES record last updated Feb 14, 2011
Key facts
- NPI
- 1053373092
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DS036716 (PA)
- Practice address
- 1433 Overlook Dr
Weirton, WV 26062-5126 - Phone
- (412) 680-0366
- NPI assigned
- Apr 5, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS036716 | PA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS036716 | PA | Yes |
Addresses
Primary practice location
1433 Overlook Dr
Weirton, WV 26062-5126
Mailing address
1433 Overlook Dr
Weirton, WV 26062-5126
Phone (412) 680-0366
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1015259710003 | Medicaid | PA | |
| 1015259710008 | Medicaid | PA | |
| 1015259710009 | Medicaid | PA | |
| 1015259710002 | Medicaid | PA | |
| 1015259710005 | Medicaid | PA | |
| 1015259710011 | Medicaid | PA | |
| 1015259710004 | Medicaid | PA | |
| 1015259710006 | Medicaid | PA | |
| 1015259710007 | Medicaid | PA | |
| 1015259710012 | Medicaid | PA | |
| 1015259710010 | Medicaid | PA | |
| 1015259710013 | Medicaid | PA | |
| 1015259710001 | Medicaid | PA |
Other providers in Weirton, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.