Ambrose Isikhuemen Obhade, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12013236A Issued in IN

Practice address

3701 S Main St Ste A150
Elkhart, IN 46517-3140

Phone

(909) 674-4602

NPI assigned

Mar 31, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1982165981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 W LEXINGTON AVE APT 105-2D",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141480",
            "telephone_number": "909-674-4602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 S MAIN ST STE A150",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465173140",
            "telephone_number": "909-674-4602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBHADE",
        "first_name": "AMBROSE",
        "middle_name": "ISIKHUEMEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-31",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12013236A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah O'Connor, MD
• Aiden O'Hara
• Jamie Marie O'Rear, M.D.
• Oaklawn Psychiatric Center, Inc.
• Oaklawn Psychiatric Center, Inc.
• Occupational Health Centers of the Southwest, PA
• Norma Odar, CRNA
• Taylor Odviar
• Karen Ogden, RPH
• Shahir Okhovat-Ghahfarokhi, M.D.

• General Practice Dentistry in Elkhart, IN
• Providers in Elkhart, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.