Provider Demographics
NPI:1578901815
Name:LESTRADE, ASHLEY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:MARIE
Last Name:LESTRADE
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 1:1510 W CAUSEWAY APPROACH STE B
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3022
Mailing Address - Country:US
Mailing Address - Phone:985-626-6166
Mailing Address - Fax:985-626-6165
Practice Address - Street 1:1510 W CAUSEWAY APPROACH STE B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3022
Practice Address - Country:US
Practice Address - Phone:985-626-6166
Practice Address - Fax:985-626-6165
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty