Provider Demographics
NPI:1861546780
Name:AMBARD, ALBERTO J (DDS PC)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:J
Last Name:AMBARD
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008
Mailing Address - Country:US
Mailing Address - Phone:503-643-6607
Mailing Address - Fax:503-526-8915
Practice Address - Street 1:6900 SW 105TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008
Practice Address - Country:US
Practice Address - Phone:503-643-6607
Practice Address - Fax:503-526-8915
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD82741223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics