Provider Demographics
NPI:1497126817
Name:AMAZING DENTAL L.L.C.
Entity Type:Organization
Organization Name:AMAZING DENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-544-2814
Mailing Address - Street 1:5740 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE# 400
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6357
Mailing Address - Country:US
Mailing Address - Phone:954-544-2814
Mailing Address - Fax:954-544-2913
Practice Address - Street 1:5740 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE# 400
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6357
Practice Address - Country:US
Practice Address - Phone:954-544-2814
Practice Address - Fax:954-544-2913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING DENTAL L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty