Healthcare Provider Details

I. General information

NPI: 1497646509
Provider Name (Legal Business Name): AMBER ACKERMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER LUST DMD

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 COMMERCE DRIVE
MOUNT HOREB WI
53572
US

IV. Provider business mailing address

4702 MADISON YARDS WAY APT 1101
MADISON WI
53705-9105
US

V. Phone/Fax

Practice location:
  • Phone: 605-832-6505
  • Fax:
Mailing address:
  • Phone: 321-512-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001912-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: