Provider Demographics
NPI:1972671014
Name:AMRO, ABDULGHANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABDULGHANI
Middle Name:
Last Name:AMRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 WEST 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-383-6200
Mailing Address - Fax:209-383-5224
Practice Address - Street 1:554 WEST 25TH STREET
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-383-6200
Practice Address - Fax:209-383-5224
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9352801Medicaid