Provider Demographics
NPI:1710255385
Name:AMS DENTAL PLLC
Entity Type:Organization
Organization Name:AMS DENTAL PLLC
Other - Org Name:BRILLIANT SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGELNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-346-0010
Mailing Address - Street 1:9750 NW 33RD ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4042
Mailing Address - Country:US
Mailing Address - Phone:954-346-0010
Mailing Address - Fax:954-346-1967
Practice Address - Street 1:9750 NW 33RD ST
Practice Address - Street 2:SUITE 217
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4042
Practice Address - Country:US
Practice Address - Phone:954-346-0010
Practice Address - Fax:954-346-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty