Provider Demographics
NPI:1467482307
Name:DAVID, AMPARO M (DMD)
Entity Type:Individual
Prefix:PROF
First Name:AMPARO
Middle Name:M
Last Name:DAVID
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1300
Mailing Address - Country:US
Mailing Address - Phone:978-779-2888
Mailing Address - Fax:978-779-6023
Practice Address - Street 1:563 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1300
Practice Address - Country:US
Practice Address - Phone:978-779-2888
Practice Address - Fax:978-779-6023
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice