Provider Demographics
NPI:1184039901
Name:COSTELLO, ASHLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 NEW SALEM HWY STE A5
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-5262
Mailing Address - Country:US
Mailing Address - Phone:615-900-2812
Mailing Address - Fax:615-546-4169
Practice Address - Street 1:2658 NEW SALEM HWY STE A5
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-5262
Practice Address - Country:US
Practice Address - Phone:615-900-2812
Practice Address - Fax:615-546-4169
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30138122300000X
TN10207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist