Provider Demographics
NPI:1689782112
Name:ASHFORD FAMILY DENTAL, INC.
Entity Type:Organization
Organization Name:ASHFORD FAMILY DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, DDS
Authorized Official - Phone:614-866-2656
Mailing Address - Street 1:1549 BRICE RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2307
Mailing Address - Country:US
Mailing Address - Phone:614-866-2656
Mailing Address - Fax:614-864-7560
Practice Address - Street 1:1549 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068
Practice Address - Country:US
Practice Address - Phone:614-866-2656
Practice Address - Fax:614-864-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0205891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30.020589OtherDENTAL LICENSE
OH2856986Medicaid