Dr. Jerrold Robert Ambrose, DMD
Dentist in Haddam, CT. Individual provider (NPI-1).
NPI number1447366307
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1447366307
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jerrold Robert Ambrose
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 22, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 4522 | CT | Yes |
Practice location
1584 Saybrook RdHaddam, CT 06438
Phone 860-345-2404
Mailing address
1584 Saybrook RoadHaddam, CT 06438
Phone 860-345-2404
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