Provider Demographics
NPI:1235285941
Name:ASHLEY, CHAD (DDS)
Entity Type:Individual
Prefix:MISS
First Name:CHAD
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 FUQUAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:IN
Mailing Address - Zip Code:47610-9226
Mailing Address - Country:US
Mailing Address - Phone:812-424-6761
Mailing Address - Fax:
Practice Address - Street 1:2300 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-5119
Practice Address - Country:US
Practice Address - Phone:812-424-6761
Practice Address - Fax:812-424-7332
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice