Provider Demographics
NPI:1124427117
Name:AMRO DENTAL CORPORATION
Entity type:Organization
Organization Name:AMRO DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDULGHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-383-6200
Mailing Address - Street 1:554 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2828
Mailing Address - Country:US
Mailing Address - Phone:209-383-6200
Mailing Address - Fax:209-383-5224
Practice Address - Street 1:554 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2828
Practice Address - Country:US
Practice Address - Phone:209-383-6200
Practice Address - Fax:209-383-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45811122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93528-01Medicaid