MEDICARE: AMG DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DN 18351	FL

General Provider Information

NPI Number	:	1376918599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMG DENTAL GROUP

Provider Business Mailing Address
First Line	:	429 NORTHLAKE BLVD
Second Line	:	SUITE 3
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5414
Country	:	US
Telephone Number	:	561-844-6146
Fax Number	:	561-844-2995

Provider Business Practice Location Address
First Line	:	429 NORTHLAKE BLVD
Second Line	:	SUITE 3
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5414
Country	:	US
Telephone Number	:	561-844-6146
Fax Number	:	561-844-2995

Authorized Official
Title or Position	:	DENTIST
Name	:	ADRIAN GUERRA
Credential	:	DDS
Telephone Number	:	561-844-6146

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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