Provider Demographics
NPI:1407268055
Name:TELLO, ASHLEY RENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:RENE
Last Name:TELLO
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 1:101 WESTERN HILLS TRL
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-6701
Mailing Address - Country:US
Mailing Address - Phone:817-776-8656
Mailing Address - Fax:817-776-8657
Practice Address - Street 1:101 WESTERN HILLS TRL
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-6701
Practice Address - Country:US
Practice Address - Phone:817-776-8656
Practice Address - Fax:817-776-8657
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist