Provider Demographics
NPI:1740386713
Name:ASHMAN DENTAL L.L.C.
Entity Type:Organization
Organization Name:ASHMAN DENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWMER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-373-6928
Mailing Address - Street 1:1355 N UNIVERSITY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2721
Mailing Address - Country:US
Mailing Address - Phone:801-373-6928
Mailing Address - Fax:801-377-2777
Practice Address - Street 1:1355 N UNIVERSITY AVE STE 300
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2721
Practice Address - Country:US
Practice Address - Phone:801-373-6928
Practice Address - Fax:801-377-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2642141223G0001X
UT1288841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty