Provider Demographics
NPI:1871759837
Name:AMBROSE, SARAH ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 E SCHNEIDMILLER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5029
Mailing Address - Country:US
Mailing Address - Phone:208-777-8668
Mailing Address - Fax:208-457-8112
Practice Address - Street 1:1910 E SCHNEIDMILLER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5029
Practice Address - Country:US
Practice Address - Phone:208-777-8668
Practice Address - Fax:208-457-8112
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-41251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice