Provider Demographics
NPI:1871744193
Name:AMBORSKI, ANDREW NICHOLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NICHOLAS
Last Name:AMBORSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 RALSTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3801
Mailing Address - Country:US
Mailing Address - Phone:419-536-7265
Mailing Address - Fax:419-724-1651
Practice Address - Street 1:1642 RALSTON CIRCLE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-3801
Practice Address - Country:US
Practice Address - Phone:419-536-7265
Practice Address - Fax:419-724-1651
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-022898122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30-022898OtherODL
OH2857449Medicaid