Provider Demographics
NPI:1235204017
Name:AMLEY & AMLEY ORTHODONTICS, P.A.
Entity Type:Organization
Organization Name:AMLEY & AMLEY ORTHODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-381-1062
Mailing Address - Street 1:5753 FIRST AVE. N.
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7913
Mailing Address - Country:US
Mailing Address - Phone:727-381-1062
Mailing Address - Fax:727-343-8337
Practice Address - Street 1:5753 FIRST AVE. N.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7913
Practice Address - Country:US
Practice Address - Phone:727-381-1062
Practice Address - Fax:727-343-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN51431223X0400X
FLDN42331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty