Provider Demographics
NPI:1841396942
Name:MACGREGOR, AMY ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELIZABETH
Last Name:MACGREGOR
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 1:2424 W ENTERPRISE RD.
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1705
Mailing Address - Country:US
Mailing Address - Phone:727-723-2157
Mailing Address - Fax:727-791-3709
Practice Address - Street 1:2424 W ENTERPRISE RD.
Practice Address - Street 2:SUITE B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1705
Practice Address - Country:US
Practice Address - Phone:727-723-2157
Practice Address - Fax:727-791-3709
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 156041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
59-3695658OtherTAX ID