Provider Demographics
NPI:1003393307
Name:CALLAHAN, ASHLEY SUSAN (RDH)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SUSAN
Last Name:CALLAHAN
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 1:711 W. MORELAND BLVD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-896-9891
Mailing Address - Fax:
Practice Address - Street 1:711 W. MORELAND BLVD.
Practice Address - Street 2:SUITE 204
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-896-9891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10844-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty