MEDICARE: AMIGOS DENTISTRY PLLC

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	261QD0000X	Dental Clinic/Center
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1609344597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIGOS DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	2020 N MASTERS DR STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-3168
Country	:	US
Telephone Number	:	972-285-2600
Fax Number	:	972-285-2605

Provider Business Practice Location Address
First Line	:	2425 S COCKRELL HILL RD STE A
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-8134
Country	:	US
Telephone Number	:	972-285-2600
Fax Number	:	972-285-2605

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HAROLD J KAMARA
Credential	:	DDS
Telephone Number	:	972-285-2600

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	11/20/2018

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