Provider Demographics
NPI:1326613803
Name:ROTHROCK, ASHLY MAUREEN (DMD)
Entity Type:Individual
Prefix:
First Name:ASHLY
Middle Name:MAUREEN
Last Name:ROTHROCK
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 1:4492 GOLDFINCH WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6640
Mailing Address - Country:US
Mailing Address - Phone:217-714-9836
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL STAFF SERVICES
Practice Address - Street 2:CODE N01H COMNAVSURFPAC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155
Practice Address - Country:US
Practice Address - Phone:619-437-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist