Provider Demographics
NPI:1821502923
Name:AMBROS-DAHILIG, KATHLEEN LUBOS (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LUBOS
Last Name:AMBROS-DAHILIG
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:LUBOS
Other - Last Name:AMBROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2240 GILPIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2240 GILPIN AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:661-618-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant