Provider Demographics
NPI:1497646509
Name:ACKERMAN, AMBER (DMD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:LUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4702 MADISON YARDS WAY APT 1101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-9105
Mailing Address - Country:US
Mailing Address - Phone:321-512-8256
Mailing Address - Fax:
Practice Address - Street 1:1920 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572
Practice Address - Country:US
Practice Address - Phone:605-832-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001912-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty