Provider Demographics
NPI:1619406345
Name:DICKERSON, ASHLEY CHRISTINE (DDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHRISTINE
Last Name:DICKERSON
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 1:8360 SHOE OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1085
Mailing Address - Country:US
Mailing Address - Phone:317-532-7436
Mailing Address - Fax:
Practice Address - Street 1:401 E 34TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3754
Practice Address - Country:US
Practice Address - Phone:317-926-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012719A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist