Healthcare Provider Details

I. General information

NPI: 1497126817
Provider Name (Legal Business Name): AMAZING DENTAL L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 HOLLYWOOD BLVD SUITE# 400
HOLLYWOOD FL
33021-6357
US

IV. Provider business mailing address

5740 HOLLYWOOD BLVD SUITE# 400
HOLLYWOOD FL
33021-6357
US

V. Phone/Fax

Practice location:
  • Phone: 954-544-2814
  • Fax: 954-544-2913
Mailing address:
  • Phone: 954-544-2814
  • Fax: 954-544-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MARY CECILIA CROSBY
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 954-544-2814