Provider Demographics
NPI:1265866057
Name:BRUBAKER, ASHLEY (DMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1035
Mailing Address - Country:US
Mailing Address - Phone:207-773-6331
Mailing Address - Fax:
Practice Address - Street 1:1423 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4707
Practice Address - Country:US
Practice Address - Phone:781-941-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856387122300000X
MEDEN4828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist