MEDICARE: DR. SANDRA CLETO AMBIDA DMD

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	1223G0001X	General Practice Dentistry	7930	CO

General Provider Information

NPI Number	:	1922171941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA CLETO AMBIDA DMD

Provider Business Mailing Address
First Line	:	9695 S YOSEMITE ST
Second Line	:	STE. 225
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	303-790-8338
Fax Number	:	303-790-8339

Provider Business Practice Location Address
First Line	:	9695 S YOSEMITE ST
Second Line	:	STE. 225
City	:	LONE TREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	303-790-8338
Fax Number	:	303-790-8339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/08/2016

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