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Organization
AMBROSE PEDIATRIC DENTISTRY OF FORSYTH, LLC
Active
Organization
AMBROSE PEDIATRIC DENTISTRY OF FORSYTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI WOOD (OFFICE MANAGER)
(478) 275-7551
Entity
Organization
Contact information
Practice address
120 N LEE ST STE D, FORSYTH, GA 31029-2122
(478) 992-6507
Mailing address
120 N LEE ST STE D, FORSYTH, GA 31029-2122
(478) 992-6507
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093197337
NPI
GA
01
—
1609953413
NPI
GA
01
—
1700972395
NPI
GA
01
—
1720193915
NPI
GA
01
—
1720441546
NPI
GA
01
—
1801134135
NPI
GA
Enumeration date
04/15/2019
Last updated
04/15/2019
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