Healthcare Provider Details

I. General information

NPI: 1689888232
Provider Name (Legal Business Name): AMBIANCE DENTAL, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MIDDLESEX RD UNIT D-3B
TYNGSBORO MA
01879-1070
US

IV. Provider business mailing address

440 MIDDLESEX RD UNIT D-3B
TYNGSBORO MA
01879-1070
US

V. Phone/Fax

Practice location:
  • Phone: 978-649-8526
  • Fax: 978-649-8528
Mailing address:
  • Phone: 978-649-8526
  • Fax: 978-649-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY T. KU
Title or Position: PRESIDENT
Credential: DMD
Phone: 978-649-8526