Provider Demographics
NPI:1922292499
Name:RICCARDO I AMBROGIO DMD PC
Entity Type:Organization
Organization Name:RICCARDO I AMBROGIO DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICCARDO
Authorized Official - Middle Name:IGNAZIO
Authorized Official - Last Name:AMBROGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-257-6994
Mailing Address - Street 1:PO BOX 290916
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0916
Mailing Address - Country:US
Mailing Address - Phone:860-257-6994
Mailing Address - Fax:860-571-7492
Practice Address - Street 1:899 SILAS DEANE HIGHWAY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-257-6994
Practice Address - Fax:860-571-7492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0073781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU27378Medicare UPIN
CTCO1812Medicare PIN