MEDICARE: DR. LAKICA R AMOS DMD

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	1223G0001X	General Practice Dentistry	5402	AL

General Provider Information

NPI Number	:	1467422741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAKICA R AMOS DMD

Provider Business Mailing Address
First Line	:	8416 OAK ST APT C
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-2058
Country	:	US
Telephone Number	:	205-276-5190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 SPRINGHILL AVE
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36604-3206
Country	:	US
Telephone Number	:	251-586-0130
Fax Number	:	251-586-0135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/21/2011

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