Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN21422 | FL |
N | 1223G0001X | General Practice | DN21422 | FL |
N | 213EG0000X | General Practice | DN21422 | FL |
N | 122400000X | Denturist | DN21422 | FL |
NPI | 1114300076 |
---|---|
Provider Name | David Luis Amador |
First Address | Southwest Ranches, FL 33331-1022 |
Second Address | Miami, FL 33177-1278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2015 |
Last Update Date | 09/07/2015 |