Individual
JOHN HUTCHINGS AMBROSE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4536 CHAMBLEE DUNWOODY RD, SUITE 211, ATLANTA, GA 30338-6200
(770) 455-1238
(770) 452-6421
Mailing address
160 PIERCE AVE, MACON, GA 31204-2871
(478) 743-0901
(478) 745-8615
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401411248
VA
1223G0001X
General Practice Dentistry
12010811A
IN
1223G0001X
General Practice Dentistry
50-052728-1
NY
1223G0001X
General Practice Dentistry
DN012737
GA
1223P0221X
Pediatric Dentistry
Primary
DN012737
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200519740A
—
IN
05
—
29364594A
—
GA
05
—
9170714
—
VA
Enumeration date
10/04/2006
Last updated
04/08/2014
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