Provider Demographics
NPI:1619721305
Name:DAVID ASHLEY MD DMD ORAL SURGERY GROUP, PC
Entity Type:Organization
Organization Name:DAVID ASHLEY MD DMD ORAL SURGERY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HOUSTON
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:205-870-1009
Mailing Address - Street 1:511 BROOKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6801
Mailing Address - Country:US
Mailing Address - Phone:205-870-1009
Mailing Address - Fax:
Practice Address - Street 1:1702 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8912
Practice Address - Country:US
Practice Address - Phone:337-541-2260
Practice Address - Fax:337-541-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty