Provider Demographics
NPI:1205089083
Name:AMBIDA FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:AMBIDA FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:CLETO
Authorized Official - Last Name:AMBIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-790-8338
Mailing Address - Street 1:9695 S YOSEMITE ST STE 225
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2890
Mailing Address - Country:US
Mailing Address - Phone:303-790-8338
Mailing Address - Fax:300-379-0833
Practice Address - Street 1:9695 S YOSEMITE ST STE 225
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2890
Practice Address - Country:US
Practice Address - Phone:303-790-8338
Practice Address - Fax:300-379-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1922171941OtherDENTAL OFFICE 'S' CORPORATION