Gabriella Daniele Ambrose, DMD
Individual provider Active NPI Periodontics · Garner, NC
NPI 1730705138 · NPPES record last updated Jun 22, 2020
Key facts
- NPI
- 1730705138
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 23091 (FL)
- Practice address
- 12450 Cleveland Rd Ste 100
Garner, NC 27529-8355 - Phone
- (919) 772-9927
- NPI assigned
- Jun 22, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20201005001806 | NC | Order and Referring Only - Dentist |
3779902176 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23091 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lane & Associates DDS Xvii PA | Multi-Specialty | Current |
Accepting new patients |
Locations
12450 Cleveland School Rd
Ste 100
Garner, NC 27529
Phone (919) 639-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics |
1223P0300X | 23091 | FL | Yes |
Addresses
Primary practice location
12450 Cleveland Rd Ste 100
Garner, NC 27529-8355
Mailing address
12450 Cleveland Rd Ste 100
Garner, NC 27529-8355
Phone (919) 772-9927
Other providers in Garner, NC
- Carrie Marie Allen
- Bianca Rose Almeida Coles
- Along in Years
- Shamekia Alvin
- Amazing Grace Supportive Services, LLC
- Paula Amezquita
- Michael Todd Amick
- Elizabeth Anderson
- Shakeria Anderson
- Erica Andrews
All providers in Garner, NC · Periodontics in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2020. 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.