Timothy L. Ambrose, DDS
Individual provider Active NPI Dentist · Gallup, NM
NPI 1003850116 · NPPES record last updated Apr 16, 2008
Key facts
- NPI
- 1003850116
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5767 (NE)
- Practice address
- 516 E. Nizhoni Blvd.
Gallup, NM 87301-1337 - Phone
- (505) 722-1000
- Fax
- (505) 722-1565
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160121001713 | TX | Order and Referring Only - Oral Surgery |
7012210206 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5767 | NE | Yes |
Addresses
Primary practice location
516 E. Nizhoni Blvd.
Gallup, NM 87301-1337
Mailing address
PO Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000R7575 | Medicaid | NM | |
| 416455 | Medicaid | AZ |
Other providers in Gallup, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.