Provider Demographics
NPI:1710248414
Name:DESAIX, ASHLEY SWINSON (DDS, MPH, D-ABDSM)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:SWINSON
Last Name:DESAIX
Suffix:
Gender:F
Credentials:DDS, MPH, D-ABDSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 BLUE RIDGE RD STE 224
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8087
Mailing Address - Country:US
Mailing Address - Phone:919-307-8960
Mailing Address - Fax:919-893-1934
Practice Address - Street 1:3200 BLUE RIDGE RD STE 224
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8087
Practice Address - Country:US
Practice Address - Phone:919-307-8960
Practice Address - Fax:919-893-1934
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NC9291122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment