Provider Demographics
NPI:1780902270
Name:AMADOR, DENNIS GABRIEL (IDC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:GABRIEL
Last Name:AMADOR
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 DOOLITTLE AVE
Mailing Address - Street 2:BHC FORT WORTH-PCC
Mailing Address - City:NAS/JRB
Mailing Address - State:TX
Mailing Address - Zip Code:76127-1133
Mailing Address - Country:US
Mailing Address - Phone:817-782-5909
Mailing Address - Fax:817-182-5949
Practice Address - Street 1:1711 DOOLITTLE AVE
Practice Address - Street 2:BHC FORT WORTH-PCC
Practice Address - City:NAS/JRB
Practice Address - State:TX
Practice Address - Zip Code:76127-1133
Practice Address - Country:US
Practice Address - Phone:817-782-5909
Practice Address - Fax:817-182-5949
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman