Provider Demographics
NPI:1285887562
Name:VESPA, AMY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:VESPA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:RYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:120 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3602
Mailing Address - Country:US
Mailing Address - Phone:727-518-8349
Mailing Address - Fax:727-518-8339
Practice Address - Street 1:120 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3602
Practice Address - Country:US
Practice Address - Phone:727-518-8349
Practice Address - Fax:727-518-8339
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO159401223G0001X
KS605861223G0001X
FL18889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice