Provider Demographics
NPI:1477901742
Name:GELDERMANS, ASHLEY
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:GELDERMANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6173 GEMINI CT
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-7838
Mailing Address - Country:US
Mailing Address - Phone:517-648-4516
Mailing Address - Fax:
Practice Address - Street 1:5278 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6131
Practice Address - Country:US
Practice Address - Phone:616-531-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist