Provider Demographics
NPI:1922171941
Name:AMBIDA, SANDRA CLETO (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:CLETO
Last Name:AMBIDA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9695 S YOSEMITE ST
Mailing Address - Street 2:STE. 225
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2888
Mailing Address - Country:US
Mailing Address - Phone:303-790-8338
Mailing Address - Fax:303-790-8339
Practice Address - Street 1:9695 S YOSEMITE ST
Practice Address - Street 2:STE. 225
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2888
Practice Address - Country:US
Practice Address - Phone:303-790-8338
Practice Address - Fax:303-790-8339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice