MEDICARE: AMA DENTAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225660541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMA DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	3370 SUGARLOAF PKWY STE G8
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5486
Country	:	US
Telephone Number	:	615-275-6669
Fax Number	:

Provider Business Practice Location Address
First Line	:	3370 SUGARLOAF PKWY STE G8
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-5486
Country	:	US
Telephone Number	:	615-275-6669
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	ANNA DUVAL N/A DUVAL
Credential	:	DDS
Telephone Number	:	615-275-6669

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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Directions to “AMA DENTAL CARE LLC ” Practice Location

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