Provider Demographics
NPI:1609451954
Name:SINGLETARY, AMBER REVELL (CRDH)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:REVELL
Last Name:SINGLETARY
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 SW 31ST DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7697
Mailing Address - Country:US
Mailing Address - Phone:850-643-7689
Mailing Address - Fax:
Practice Address - Street 1:1220 NE 36TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4931
Practice Address - Country:US
Practice Address - Phone:352-732-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27904124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist