Provider Demographics
NPI:1932616232
Name:AML DENTISTRY
Entity Type:Organization
Organization Name:AML DENTISTRY
Other - Org Name:PARK LAKE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:MINEAR
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-841-7321
Mailing Address - Street 1:304 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1206
Mailing Address - Country:US
Mailing Address - Phone:407-841-7321
Mailing Address - Fax:
Practice Address - Street 1:304 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1206
Practice Address - Country:US
Practice Address - Phone:407-841-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19831261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1861757460OtherINDIVIDUAL NPI