Healthcare Provider Details

I. General information

NPI: 1922487750
Provider Name (Legal Business Name): AMA DENTAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 OLD PLEASANT HILL RD
KISSIMMEE FL
34759-3423
US

IV. Provider business mailing address

4671 OLD PLEASANT HILL RD
KISSIMMEE FL
34759-3423
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-7910
  • Fax: 407-201-7911
Mailing address:
  • Phone: 407-201-7910
  • Fax: 407-201-7911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. ALFREDO MUNOZ
Title or Position: DENTIST
Credential: DMD
Phone: 407-201-7910