Provider Demographics
NPI:1558083469
Name:CARLISLE, ASHLEY ANNE (RDH)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANNE
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 TOUCHET GARDENA RD
Mailing Address - Street 2:
Mailing Address - City:TOUCHET
Mailing Address - State:WA
Mailing Address - Zip Code:99360-9603
Mailing Address - Country:US
Mailing Address - Phone:360-207-1988
Mailing Address - Fax:
Practice Address - Street 1:538 TOUCHET GARDENA RD
Practice Address - Street 2:
Practice Address - City:TOUCHET
Practice Address - State:WA
Practice Address - Zip Code:99360-9603
Practice Address - Country:US
Practice Address - Phone:509-301-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00007894124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist