MEDICARE: A&M DENTAL GROUP 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	1223P0221X	Pediatric 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	:	1447726922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&M DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	1202 CYPRESS GLEN CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-7563
Country	:	US
Telephone Number	:	407-810-0450
Fax Number	:

Provider Business Practice Location Address
First Line	:	8255 LEE VISTA BLVD STE F-G
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-8018
Country	:	US
Telephone Number	:	407-810-0450
Fax Number	:

Authorized Official
Title or Position	:	MGRM
Name	:	DR. MIGUEL TABARES
Credential	:	DDS
Telephone Number	:	407-810-0467

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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Directions to “A&M DENTAL GROUP LLC ” Practice Location

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