Provider Demographics
NPI:1225660541
Name:AMA DENTAL CARE LLC
Entity Type:Organization
Organization Name:AMA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA DUVAL
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-275-6669
Mailing Address - Street 1:3370 SUGARLOAF PKWY STE G8
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5486
Mailing Address - Country:US
Mailing Address - Phone:615-275-6669
Mailing Address - Fax:
Practice Address - Street 1:3370 SUGARLOAF PKWY STE G8
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5486
Practice Address - Country:US
Practice Address - Phone:615-275-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1346491636Medicaid