Provider Demographics
NPI:1861732927
Name:AMBORN, REID MICHAEL (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:REID
Middle Name:MICHAEL
Last Name:AMBORN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1810 E NOB HILL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5238
Mailing Address - Country:US
Mailing Address - Phone:503-581-8141
Mailing Address - Fax:503-375-2808
Practice Address - Street 1:1810 E NOB HILL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5238
Practice Address - Country:US
Practice Address - Phone:503-581-8141
Practice Address - Fax:503-375-2808
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD61471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics