Provider Demographics
NPI:1376918599
Name:AMG DENTAL GROUP
Entity Type:Organization
Organization Name:AMG DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-844-6146
Mailing Address - Street 1:429 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5414
Mailing Address - Country:US
Mailing Address - Phone:561-844-6146
Mailing Address - Fax:561-844-2995
Practice Address - Street 1:429 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5414
Practice Address - Country:US
Practice Address - Phone:561-844-6146
Practice Address - Fax:561-844-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18351261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental