Provider Demographics
NPI:1467422741
Name:AMOS, LAKICA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAKICA
Middle Name:R
Last Name:AMOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 OAK ST APT C
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-2058
Mailing Address - Country:US
Mailing Address - Phone:205-276-5190
Mailing Address - Fax:
Practice Address - Street 1:1501 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3206
Practice Address - Country:US
Practice Address - Phone:251-586-0130
Practice Address - Fax:251-586-0135
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice