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General NPI Number Information
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NPI Number | 1922292499
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Entity Type | Organization
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Legal Business Name | RICCARDO I AMBROGIO DMD PC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 899 SILAS DEANE HIGHWAY
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City | WETHERSFIELD
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State | CT
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Zip | 06109
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Country | US
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Telephone | 860-257-6994
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Fax | 860-571-7492
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Provider Business Mailing Address
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Address Line | PO BOX 290916
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City | WETHERSFIELD
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State | CT
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Zip | 06129-0916
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Country | US
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Telephone | 860-257-6994
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Fax | 860-571-7492
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICCARDO IGNAZIO AMBROGIO
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Credential | DMD
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Telephone | 860-257-6994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 007378
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License Number State | CT
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