Provider Demographics
NPI:1982471751
Name:AMBROSE PEDIATRIC DENTISTRY OF MILLEDGEVILLE
Entity Type:Organization
Organization Name:AMBROSE PEDIATRIC DENTISTRY OF MILLEDGEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-743-0901
Mailing Address - Street 1:120 N LEE ST STE J
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-2122
Mailing Address - Country:US
Mailing Address - Phone:478-992-6507
Mailing Address - Fax:
Practice Address - Street 1:2485 N COLUMBIA ST STE 89
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-5400
Practice Address - Country:US
Practice Address - Phone:478-210-6625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental