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General NPI Number Information
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NPI Number | 1083094213
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Entity Type | Individual
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Provider Name | DOMINICK JOACHIN AMBROISE D.D.S., M.A.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 10/15/2016
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Provider Practice Location Address
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Address Line | 475 N BRIDGE ST
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2153
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Country | US
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Telephone | 908-947-0320
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 3RD AVE
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City | ASBURY PARK
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State | NJ
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Zip | 07712-5720
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Country | US
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Telephone | 347-405-3323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02623300
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License Number State | NJ
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