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General NPI Number Information
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NPI Number | 1972342939
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Entity Type | Individual
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Provider Name | AMIR ADEL TADROS DDS
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Gender | Male
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 940 CHURCH RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9611
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Country | US
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Telephone | 662-253-8027
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Fax |
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Provider Business Mailing Address
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Address Line | 736 FOREST LAKE DR
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City | MEMPHIS
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State | TN
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Zip | 38117-5006
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4441-24
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License Number State | MS
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