Provider Demographics
NPI:1477246387
Name:DALAL, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:DALAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 NORTHWAY CIR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7110
Mailing Address - Country:US
Mailing Address - Phone:908-590-1753
Mailing Address - Fax:
Practice Address - Street 1:1624 CHOTO MARKETS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5760
Practice Address - Country:US
Practice Address - Phone:865-409-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0271431223G0001X
TN121971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice