Healthcare Provider Details

I. General information

NPI: 1992203707
Provider Name (Legal Business Name): AMIR BEG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6882 GULFPORT BLVD S
SOUTH PASADENA FL
33707
US

IV. Provider business mailing address

1454 COVE LANDING DR
JACKSONVILLE FL
32233-2058
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-9655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: