Individual
OLEG AMAYEV
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10847 BUSTLETON AVE, PHILADELPHIA, PA 19116-3301
(215) 552-9800
(215) 552-9876
Mailing address
10847 BUSTLETON AVE, PHILADELPHIA, PA 19116-3301
(215) 552-9800
(215) 552-9876
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS036113
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010462950001
—
PA
Enumeration date
10/14/2005
Last updated
07/08/2007
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