Provider Demographics
NPI:1356157820
Name:AMG DENTAL GROUP PC
Entity type:Organization
Organization Name:AMG DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL RAHMAN ADDAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-560-0858
Mailing Address - Street 1:344 GIFFORD ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-5109
Mailing Address - Country:US
Mailing Address - Phone:508-524-3732
Mailing Address - Fax:
Practice Address - Street 1:344 GIFFORD ST UNIT A
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-5109
Practice Address - Country:US
Practice Address - Phone:508-524-3732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMG DENTAL GROUP PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty