Provider Demographics
NPI:1851341606
Name:MACIAS, AMBER MOORE (DDS)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MOORE
Last Name:MACIAS
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 1:1148 MACIAS CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4247
Mailing Address - Country:US
Mailing Address - Phone:719-375-4162
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY CIR RM 420
Practice Address - Street 2:BDC MONTEREY, NPS
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93943-5098
Practice Address - Country:US
Practice Address - Phone:719-375-4162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice