Provider Demographics
NPI:1114300076
Name:AMADOR, DAVID LUIS (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LUIS
Last Name:AMADOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18050 SW 50TH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1022
Mailing Address - Country:US
Mailing Address - Phone:954-605-4954
Mailing Address - Fax:
Practice Address - Street 1:15940 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1278
Practice Address - Country:US
Practice Address - Phone:305-259-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21422122300000X, 1223G0001X, 122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No122400000XDental ProvidersDenturist