Provider Demographics
NPI:1558012054
Name:RODRIGUEZ, ASHLEY (BS, RDH)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BS, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 W MIDVALE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4725
Mailing Address - Country:US
Mailing Address - Phone:423-313-3085
Mailing Address - Fax:
Practice Address - Street 1:5550 HIGHWAY 153 STE 100
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4991
Practice Address - Country:US
Practice Address - Phone:423-875-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH010990124Q00000X
TN7111124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist