Provider Demographics
NPI:1215076724
Name:AMBROSIANO, LUISA (DDS)
Entity type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:AMBROSIANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 TAMALPAIS DR
Mailing Address - Street 2:SUITE #205
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1700
Mailing Address - Country:US
Mailing Address - Phone:415-924-2022
Mailing Address - Fax:415-924-1371
Practice Address - Street 1:770 TAMALPAIS DR
Practice Address - Street 2:SUITE #205
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1700
Practice Address - Country:US
Practice Address - Phone:415-924-2022
Practice Address - Fax:415-924-1371
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice