Provider Demographics
NPI:1922584291
Name:DOBROZDRAVIC, AMY BETH (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:DOBROZDRAVIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 E STATE ROAD 50
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3184
Mailing Address - Country:US
Mailing Address - Phone:352-241-4500
Mailing Address - Fax:352-988-6454
Practice Address - Street 1:680 E STATE ROAD 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3184
Practice Address - Country:US
Practice Address - Phone:352-241-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice