Provider Demographics
NPI:1396785507
Name:AMBROSI, MARK GENE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GENE
Last Name:AMBROSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 GRAMATAN AVE
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1604
Mailing Address - Country:US
Mailing Address - Phone:914-664-7013
Mailing Address - Fax:
Practice Address - Street 1:680 GRAMATAN AVE
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1604
Practice Address - Country:US
Practice Address - Phone:914-664-7013
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0331321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice