Provider Demographics
NPI:1720369119
Name:MCTRUSTY, ASHLEI ELAINE (RDH)
Entity Type:Individual
Prefix:
First Name:ASHLEI
Middle Name:ELAINE
Last Name:MCTRUSTY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N15638 OLD 38 RD
Mailing Address - Street 2:
Mailing Address - City:AMBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54102-9245
Mailing Address - Country:US
Mailing Address - Phone:715-929-0030
Mailing Address - Fax:
Practice Address - Street 1:15397 STATE HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WI
Practice Address - Zip Code:54138-9702
Practice Address - Country:US
Practice Address - Phone:715-276-6321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10467-016124Q00000X
HI1555124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist