Provider Demographics
NPI:1801134135
Name:AMBROSE, VALERIE W (DMD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:W
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2871
Mailing Address - Country:US
Mailing Address - Phone:478-743-0901
Mailing Address - Fax:478-745-8615
Practice Address - Street 1:160 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2871
Practice Address - Country:US
Practice Address - Phone:478-743-0901
Practice Address - Fax:478-745-8615
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013328122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist