MEDICARE: DR. ALBERTO AMBRIZ DDS, MDT

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	122300000X	Dentist	30812	TX

General Provider Information

NPI Number	:	1952683450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERTO AMBRIZ DDS, MDT

Provider Business Mailing Address
First Line	:	9400 N CENTRAL EXPY STE 220
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5061
Country	:	US
Telephone Number	:	214-368-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 N CENTRAL EXPY STE 220
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5061
Country	:	US
Telephone Number	:	214-368-0514
Fax Number	:

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	12/08/2023

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