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General NPI Number Information
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NPI Number | 1235673740
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Entity Type | Organization
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Legal Business Name | AMBASSADOR PRACTICE MANAGEMENT, LLC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 104 W OAK HWY
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City | WESTMINSTER
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State | SC
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Zip | 29693-2226
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Country | US
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Telephone | 864-647-9000
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Fax | 425-671-0756
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Provider Business Mailing Address
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Address Line | 123 GROVE AVE #101
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City | CEDARHURST
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State | NY
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Zip | 11516-2322
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Country | US
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Telephone | 425-503-1607
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Fax | 425-671-0756
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Authorized Official
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Title or Position | OWNER / MANAGER
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Name | NACHUM AUGENBAUM
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Credential | DDS
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Telephone | 864-647-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3059
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License Number State | SC
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