Provider Demographics
NPI:1467654335
Name:CARNEY & AMBROSE, DDS, LLC
Entity Type:Organization
Organization Name:CARNEY & AMBROSE, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-634-3316
Mailing Address - Street 1:207 METRO DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1134
Mailing Address - Country:US
Mailing Address - Phone:573-634-3316
Mailing Address - Fax:573-636-5050
Practice Address - Street 1:207 METRO DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1134
Practice Address - Country:US
Practice Address - Phone:573-634-3316
Practice Address - Fax:573-636-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040132441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty