Provider Demographics
NPI:1568156446
Name:AMBERG, MANDY (DDS)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:AMBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 S 20TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-2398
Mailing Address - Country:US
Mailing Address - Phone:531-910-7980
Mailing Address - Fax:
Practice Address - Street 1:2100 S 20TH ST STE 3
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-2398
Practice Address - Country:US
Practice Address - Phone:531-910-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice