Provider Demographics
NPI:1083094213
Name:AMBROISE, DOMINICK JOACHIN (DDS, MA)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:JOACHIN
Last Name:AMBROISE
Suffix:
Gender:M
Credentials:DDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5720
Mailing Address - Country:US
Mailing Address - Phone:347-405-3323
Mailing Address - Fax:
Practice Address - Street 1:475 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2153
Practice Address - Country:US
Practice Address - Phone:908-947-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02623300122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist