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General NPI Number Information
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NPI Number | 1548146038
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Entity Type | Individual
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Provider Name | DR. JARED AMBROSE
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Gender | Male
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 2441 21ST ST
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5582
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Country | US
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Telephone | 270-798-8953
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Fax |
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Provider Business Mailing Address
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Address Line | 525 WOODTRACE DR
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City | CLARKSVILLE
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State | TN
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Zip | 37042-6185
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11440
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License Number State | KY
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