Provider Demographics
NPI:1235813759
Name:KERSLAKE, ASHLEY MARIAH (DDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIAH
Last Name:KERSLAKE
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 1:5061 SHADY OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52214-9505
Mailing Address - Country:US
Mailing Address - Phone:319-432-5169
Mailing Address - Fax:
Practice Address - Street 1:4332 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3181
Practice Address - Country:US
Practice Address - Phone:319-365-4997
Practice Address - Fax:319-365-6822
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-101181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice