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General NPI Number Information
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NPI Number | 1861732927
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Entity Type | Individual
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Provider Name | REID MICHAEL AMBORN D.M.D., M.S.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 1810 E NOB HILL ST SE
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City | SALEM
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State | OR
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Zip | 97302-5238
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Country | US
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Telephone | 503-581-8141
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Fax | 503-375-2808
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Provider Business Mailing Address
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Address Line | 1810 E NOB HILL ST SE
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City | SALEM
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State | OR
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Zip | 97302-5238
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Country | US
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Telephone | 503-581-8141
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Fax | 503-375-2808
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D6147
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License Number State | OR
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