Basic Information
| Provider Information | |||||||||
| NPI: | 1073894606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMBROSE | ||||||||
| FirstName: | LATOYA | ||||||||
| MiddleName: | SYMONE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 N BROADWAY STE 102 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212131437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439571602 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4018 GEORGIA AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200115857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028294319 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2011 | ||||||||
| LastUpdateDate: | 08/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN1001087 | DC | N | Dental Providers | Dentist | 1223G0001X | 15284 | MD | Y | Dental Providers | Dentist | General Practice |
No ID Information.