Provider Demographics
NPI:1437703535
Name:AMBIANCE SURGICAL ARTS CENTER
Entity Type:Organization
Organization Name:AMBIANCE SURGICAL ARTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:D
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-377-4344
Mailing Address - Street 1:8501 SW 124TH AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4633
Mailing Address - Country:US
Mailing Address - Phone:786-377-4344
Mailing Address - Fax:786-377-4364
Practice Address - Street 1:8501 SW 124TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4633
Practice Address - Country:US
Practice Address - Phone:786-377-4344
Practice Address - Fax:786-377-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTPVP162861-09Medicaid