Provider Demographics
NPI:1548060429
Name:AMBROZ, ALICIA GRACE (RDH)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:GRACE
Last Name:AMBROZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RURAL VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16249-4505
Mailing Address - Country:US
Mailing Address - Phone:724-954-4955
Mailing Address - Fax:
Practice Address - Street 1:415 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RURAL VALLEY
Practice Address - State:PA
Practice Address - Zip Code:16249-4505
Practice Address - Country:US
Practice Address - Phone:724-954-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADHA001934124Q00000X
PADH071626124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist