MEDICARE: MS. KATHLEEN LUBOS AMBROS-DAHILIG DENTAL ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant

General Provider Information

NPI Number	:	1821502923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN LUBOS AMBROS-DAHILIG DENTAL ASSISTANT

Provider Business Mailing Address
First Line	:	2240 GILPIN AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3270
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 GILPIN AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910
Country	:	US
Telephone Number	:	661-618-8280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	06/18/2018

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