Provider Demographics
NPI:1073894606
Name:AMBROSE, LATOYA SYMONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:SYMONE
Last Name:AMBROSE
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 1:1900 N BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1437
Mailing Address - Country:US
Mailing Address - Phone:443-957-1602
Mailing Address - Fax:
Practice Address - Street 1:4018 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5857
Practice Address - Country:US
Practice Address - Phone:202-829-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001087122300000X
MD152841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist