Provider Demographics
NPI:1831751635
Name:AMARAL, CARL SWANSON (DDS)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:SWANSON
Last Name:AMARAL
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 1:16595 SW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4644
Mailing Address - Country:US
Mailing Address - Phone:954-496-1274
Mailing Address - Fax:
Practice Address - Street 1:463859 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3639
Practice Address - Country:US
Practice Address - Phone:904-335-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN243661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty