Provider Demographics
NPI:1710757315
Name:AMBROZIC, KRISTEN (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:AMBROZIC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BREYMAIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3602 RUGBY DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4425
Mailing Address - Country:US
Mailing Address - Phone:419-385-1671
Mailing Address - Fax:
Practice Address - Street 1:7924 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9619
Practice Address - Country:US
Practice Address - Phone:734-856-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist