Provider Demographics
NPI:1669450706
Name:ASH, CAROLYN M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:ASH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5368 EVERGREEN HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7532
Mailing Address - Country:US
Mailing Address - Phone:541-973-6717
Mailing Address - Fax:
Practice Address - Street 1:1120 WELLINGTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6130
Practice Address - Country:US
Practice Address - Phone:970-242-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0342981223P0700X
ORD99701223P0700X
MI0170081223P0700X
CO002030771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI20150924000871Medicaid