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General NPI Number Information
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NPI Number | 1144812348
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Entity Type | Organization
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Legal Business Name | AMP ORAL AND MAXILLOFACIAL SURGERY, PA
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 3861 AVALON PARK EAST BLVD
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City | ORLANDO
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State | FL
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Zip | 32828-4853
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Country | US
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Telephone | 407-544-0139
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Fax |
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Provider Business Mailing Address
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Address Line | 10524 MOSS PARK RD STE 204-616
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City | ORLANDO
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State | FL
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Zip | 32832-5898
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Country | US
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Telephone | 678-480-9808
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | DR. JONATHAN CLINTON ELMORE
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Credential | DDS
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Telephone | 678-480-9808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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