Provider Demographics
NPI:1740435858
Name:AMARGOS, MARIA DE LOURDES (DDS)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE LOURDES
Last Name:AMARGOS
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 1:11541 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6566
Mailing Address - Country:US
Mailing Address - Phone:305-253-0645
Mailing Address - Fax:305-253-3687
Practice Address - Street 1:11541 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6566
Practice Address - Country:US
Practice Address - Phone:305-253-0645
Practice Address - Fax:305-253-3687
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL074150700Medicaid