Provider Demographics
NPI:1740578244
Name:ASHLEY, CHANDA MARIE (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:MARIE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3418
Mailing Address - Country:US
Mailing Address - Phone:540-885-6815
Mailing Address - Fax:
Practice Address - Street 1:211 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3418
Practice Address - Country:US
Practice Address - Phone:540-885-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCFA1845518OtherCONTROLLED SUBSTANCE REGISTRATION CERTIFICATE