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Organization
AMP ORAL AND MAXILLOFACIAL SURGERY, PA
Active
Organization
AMP ORAL AND MAXILLOFACIAL SURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN CLINTON ELMORE DDS (OWNER/AUTHORIZED OFFICIAL)
(678) 480-9808
Entity
Organization
Contact information
Practice address
3861 AVALON PARK EAST BLVD, ORLANDO, FL 32828-4853
(407) 544-0139
Mailing address
10524 MOSS PARK RD STE 204-616, ORLANDO, FL 32832-5898
(678) 480-9808
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
02/09/2021
Last updated
04/22/2024
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