Provider Demographics
NPI:1073863890
Name:FEMME AMBROSIO, DDS, MSD, INC
Entity type:Organization
Organization Name:FEMME AMBROSIO, DDS, MSD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FEMME
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:858-603-6345
Mailing Address - Street 1:12467 SUNDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2241
Mailing Address - Country:US
Mailing Address - Phone:858-603-6345
Mailing Address - Fax:
Practice Address - Street 1:16918 DOVE CANYON RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3501
Practice Address - Country:US
Practice Address - Phone:858-451-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty