Provider Demographics
NPI:1578940912
Name:AMADOR DMD, PA, MIRTHA
Entity Type:Individual
Prefix:
First Name:MIRTHA
Middle Name:
Last Name:AMADOR DMD, PA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 ALMERIA AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5801
Mailing Address - Country:US
Mailing Address - Phone:305-569-9001
Mailing Address - Fax:305-444-9882
Practice Address - Street 1:357 ALMERIA AVE
Practice Address - Street 2:STE 105
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5801
Practice Address - Country:US
Practice Address - Phone:305-569-9001
Practice Address - Fax:305-444-9882
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist