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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