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DR. JERROLD ROBERT AMBROSE DMD

>> Dentist >> Dental Providers

Registrant NPI Number: 1447366307

Individual Registrant:
DR. JERROLD ROBERT AMBROSE DMD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
1584 SAYBROOK RD  HADDAM, CT 06438 US
Tel: 860-345-2404  Fax: --

Contact information for business:
1584 SAYBROOK ROAD  HADDAM, CT 06438 US
Tel: 860-345-2404  Fax: --

Registration Information:
NPI: 1447366307
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y122300000XDental Providers
Dentist
CT4522

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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