Henry Nishan Ambrookian Jr., D.D.S.

Key facts

NPI

1295841203

Entity type

Individual (NPI type 1)

Primary specialty

Oral and Maxillofacial Surgery (Dentist) 1223S0112X

License

5001837-015 (WI)

Practice address

1201 Oak St
West Bend, WI 53095-3800

Phone

(262) 334-7172

Fax

(262) 334-7166

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

National Provider Directory

Medicare enrollment (NPD)

Yes

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295841203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11405 N CARRIAGE CT",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530922145",
            "telephone_number": "262-242-2350",
            "fax_number": "262-238-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 OAK ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953800",
            "telephone_number": "262-334-7172",
            "fax_number": "262-334-7166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROOKIAN",
        "first_name": "HENRY",
        "middle_name": "NISHAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "5001837-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in West Bend, WI · Oral and Maxillofacial Surgery (Dentist) in Wisconsin