Provider Demographics
NPI:1447726922
Name:A&M DENTAL GROUP LLC
Entity type:Organization
Organization Name:A&M DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TABARES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-810-0467
Mailing Address - Street 1:1202 CYPRESS GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7563
Mailing Address - Country:US
Mailing Address - Phone:407-810-0450
Mailing Address - Fax:
Practice Address - Street 1:8255 LEE VISTA BLVD STE F-G
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8018
Practice Address - Country:US
Practice Address - Phone:407-810-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty