Provider Demographics
NPI:1942213129
Name:AMBERMAN, BENJAMIN DOUGLAS (DDS, MS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DOUGLAS
Last Name:AMBERMAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35522 CENTER RIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3020
Mailing Address - Country:US
Mailing Address - Phone:440-327-7511
Mailing Address - Fax:440-327-2612
Practice Address - Street 1:35522 CENTER RIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3020
Practice Address - Country:US
Practice Address - Phone:440-327-7511
Practice Address - Fax:440-327-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics