MEDICARE: FEMME AMBROSIO, DDS, MSD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	60250	CA

General Provider Information

NPI Number	:	1073863890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEMME AMBROSIO, DDS, MSD, INC

Provider Business Mailing Address
First Line	:	12467 SUNDANCE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2241
Country	:	US
Telephone Number	:	858-603-6345
Fax Number	:

Provider Business Practice Location Address
First Line	:	16918 DOVE CANYON RD
Second Line	:	SUITE 204
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-3501
Country	:	US
Telephone Number	:	858-451-5400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FEMME AMBROSIO
Credential	:	DDS MSD
Telephone Number	:	858-603-6345

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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