| Narissa Ambata Dds Inc | |
|
4509 Slauson Ave Suite B Maywood CA 90270-2954 | |
| (323) 560-8999 | |
| Not Available |
| Full Name | Narissa Ambata Dds Inc |
|---|---|
| Speciality | Dentist |
| Location | 4509 Slauson Ave, Maywood, California |
| Authorized Official Name and Position | Narissa Bawalan Ambata (OWNER) |
| Authorized Official Contact | 3235608999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Narissa Ambata Dds Inc 4509 Slauson Ave Suite B Maywood CA 90270-2954 Ph: (323) 560-8999 | Narissa Ambata Dds Inc 4509 Slauson Ave Suite B Maywood CA 90270-2954 Ph: (323) 560-8999 |
| NPI Number | 1467863647 |
|---|---|
| Provider Enumeration Date | 05/09/2014 |
| Last Update Date | 04/15/2019 |
| Medicare PECOS PAC ID | 0345583746 |
|---|---|
| Medicare Enrollment ID | O20190529001122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467863647 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 61070 (California) | Primary |
| Provider Name | Narissa B Ambata |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1538582564 PECOS PAC ID: 1254674658 Enrollment ID: I20190529001298 |
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