Provider Demographics
NPI:1972914331
Name:AMBROSE, TERRI MARTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:MARTINA
Last Name:AMBROSE
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 1:932 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4022
Mailing Address - Country:US
Mailing Address - Phone:718-755-9631
Mailing Address - Fax:
Practice Address - Street 1:932 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4022
Practice Address - Country:US
Practice Address - Phone:718-755-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163831223P0221X
390200000X
NY500579331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program