Jerrold Robert Ambrose, DMD
Individual provider Active NPI Dentist · Haddam, CT
NPI 1447366307 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1447366307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 4522 (CT)
- Practice address
- 1584 Saybrook Rd
Haddam, CT 06438 - Phone
- (860) 345-2404
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4522 | CT | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4522 | CT | Yes |
Addresses
Primary practice location
1584 Saybrook Rd
Haddam, CT 06438
Mailing address
1584 Saybrook Road
Haddam, CT 06438
Phone (860) 345-2404
Other providers in Haddam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.