Provider Demographics
NPI:1568820009
Name:GREEN, ASHLEY NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NICOLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2221 W LEDBETTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4746
Mailing Address - Country:US
Mailing Address - Phone:214-234-8444
Mailing Address - Fax:214-234-8444
Practice Address - Street 1:2221 W. LEDBETTER DRIVE, SUITE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:214-234-8444
Practice Address - Fax:214-234-8444
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX320091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry