Provider Demographics
NPI:1902041569
Name:ADVANCED AESTHETICS DENTAL STUDIO
Entity Type:Organization
Organization Name:ADVANCED AESTHETICS DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMARDEEP
Authorized Official - Middle Name:DAVE
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-991-1111
Mailing Address - Street 1:27516 CASHFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6910
Mailing Address - Country:US
Mailing Address - Phone:813-991-1111
Mailing Address - Fax:813-991-0061
Practice Address - Street 1:27516 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6910
Practice Address - Country:US
Practice Address - Phone:813-991-1111
Practice Address - Fax:813-991-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty