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General NPI Number Information
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NPI Number | 1467863647
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Entity Type | Organization
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Legal Business Name | NARISSA AMBATA DDS INC
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 4509 SLAUSON AVE SUITE B
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City | MAYWOOD
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State | CA
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Zip | 90270-2954
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Country | US
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Telephone | 323-560-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 4509 SLAUSON AVE SUITE B
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City | MAYWOOD
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State | CA
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Zip | 90270-2954
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Country | US
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Telephone | 323-560-8999
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NARISSA BAWALAN AMBATA
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Credential | DDS
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Telephone | 323-560-8999
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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 | 61070
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License Number State | CA
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