# AMBROSE DENTAL OFFICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588981104
- **Authorized official:** DR. JAMES K. AMBROSE D.D.S. (OWNER)
- **Authorized official phone:** (580) 782-5513

## Contact information

- **Practice address:** 1410 1/2 N LOUIS TITTLE AVE, MANGUM, OK 73554-2218
- **Practice address phone:** (580) 782-5513
- **Practice address fax:** (580) 782-5156
- **Mailing address:** PO BOX 326, MANGUM, OK 73554-0326
- **Mailing address phone:** (580) 782-5513
- **Mailing address fax:** (580) 782-5156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4334 | OK | Yes |

## Other

- **Enumeration date:** 04/21/2010
- **Last updated:** 04/21/2010