Provider Demographics
NPI:1003374919
Name:AMBRIDGE, MARINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:AMBRIDGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25355 N LAKE PLEASANT PKWY UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1504
Mailing Address - Country:US
Mailing Address - Phone:480-468-0335
Mailing Address - Fax:623-825-6885
Practice Address - Street 1:25355 N LAKE PLEASANT PKWY UNIT 103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1504
Practice Address - Country:US
Practice Address - Phone:480-468-0335
Practice Address - Fax:623-825-6885
Is Sole Proprietor?:No
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist