Provider Demographics
NPI:1568502219
Name:ANDERSON, ASHLEY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:E
Last Name:ANDERSON
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 1:18 W RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1684
Mailing Address - Country:US
Mailing Address - Phone:614-208-4812
Mailing Address - Fax:
Practice Address - Street 1:3646 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2913
Practice Address - Country:US
Practice Address - Phone:614-231-4800
Practice Address - Fax:614-231-4801
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300223651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH260135218035OtherCARE SOURCE PROVIDER #
OH9185651OtherDORAL PROVIDER #
OH2672031Medicaid