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General NPI Number Information
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NPI Number | 1649350349
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Entity Type | Organization
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Legal Business Name | AMELIA DENTAL GROUP, PLLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 1947 CITRONA DRIVE
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-261-7181
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Fax | 904-261-9797
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Provider Business Mailing Address
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Address Line | 1947 CITRONA DRIVE
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 904-261-7181
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Fax | 904-261-9797
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Authorized Official
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Title or Position | SEC
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Name | DR. LAURIE KITSON
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Credential | DMD
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Telephone | 904-261-7181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN3529
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN17599
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN20603
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN21208
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN11327
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15429
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License Number State | FL
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