Provider Demographics
NPI:1538698352
Name:EDELBURG, ASHLEY ROSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ROSE
Last Name:EDELBURG
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:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:SD
Mailing Address - Zip Code:57551-0912
Mailing Address - Country:US
Mailing Address - Phone:715-571-0985
Mailing Address - Fax:
Practice Address - Street 1:103 E BENNETT AVE
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:SD
Practice Address - Zip Code:57551-2203
Practice Address - Country:US
Practice Address - Phone:605-685-1046
Practice Address - Fax:605-685-6756
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist