Provider Demographics
NPI:1477080901
Name:AMBER M. NIERODE, DDS, INC.
Entity Type:Organization
Organization Name:AMBER M. NIERODE, DDS, INC.
Other - Org Name:SANTA ROSA PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:NIERODE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-717-0364
Mailing Address - Street 1:515 FARMERS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4917
Mailing Address - Country:US
Mailing Address - Phone:714-717-0364
Mailing Address - Fax:
Practice Address - Street 1:515 FARMERS LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4917
Practice Address - Country:US
Practice Address - Phone:714-717-0364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty