Provider Demographics
NPI:1316152507
Name:JOHN W. AMBURGEY DDS PA
Entity type:Organization
Organization Name:JOHN W. AMBURGEY DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:AMBURGEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-626-6140
Mailing Address - Street 1:28668 U. S. HWY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7008
Mailing Address - Country:US
Mailing Address - Phone:251-626-6140
Mailing Address - Fax:251-626-0950
Practice Address - Street 1:28668 U S HWY 98
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7008
Practice Address - Country:US
Practice Address - Phone:251-626-6140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3567122300000X
AL2524122300000X
AL4347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty