MEDICARE: DR. AMBER DENISE O'CONNOR DDS

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	29908	TX

General Provider Information

NPI Number	:	1699188896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER DENISE O'CONNOR DDS

Provider Business Mailing Address
First Line	:	1900 HI LINE DR APT 342
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-3366
Country	:	US
Telephone Number	:	817-269-6518
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 CEDAR SPRINGS RD STE 110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-7885
Country	:	US
Telephone Number	:	214-969-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/05/2014

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