Provider Demographics
NPI:1568727816
Name:AMBROSON, ABBEY ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABBEY
Middle Name:ROSE
Last Name:AMBROSON
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 1:515 GRANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-3220
Mailing Address - Country:US
Mailing Address - Phone:515-360-2678
Mailing Address - Fax:
Practice Address - Street 1:322 DENTAL SCIENCE BLDG S
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1001
Practice Address - Country:US
Practice Address - Phone:319-384-1139
Practice Address - Fax:319-384-1785
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program