Provider Demographics
NPI:1639528557
Name:MERRYMAN, ASHLEY N (DDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:MERRYMAN
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 1:16528 NE 35TH CT APT QQ102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6375
Mailing Address - Country:US
Mailing Address - Phone:317-752-5435
Mailing Address - Fax:
Practice Address - Street 1:16528 NE 35TH CT APT QQ102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6375
Practice Address - Country:US
Practice Address - Phone:317-752-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60662109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist