Provider Demographics
NPI:1952454019
Name:AMBROSIO, BERNABE BARR URBANO (DMD)
Entity Type:Individual
Prefix:DR
First Name:BERNABE BARR
Middle Name:URBANO
Last Name:AMBROSIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12120 ALTA CARMEL CT
Mailing Address - Street 2:SUITE 410C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3864
Mailing Address - Country:US
Mailing Address - Phone:858-385-9188
Mailing Address - Fax:858-385-9328
Practice Address - Street 1:12120 ALTA CARMEL CT
Practice Address - Street 2:SUITE 410C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3864
Practice Address - Country:US
Practice Address - Phone:858-385-9188
Practice Address - Fax:858-385-9328
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice