Provider Demographics
NPI:1831107788
Name:ASHMORE, ISLO D (WINN) (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISLO
Middle Name:D (WINN)
Last Name:ASHMORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 NW 23RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107
Mailing Address - Country:US
Mailing Address - Phone:405-949-0123
Mailing Address - Fax:405-949-9762
Practice Address - Street 1:3104 NW 23RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-949-0123
Practice Address - Fax:405-949-9762
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
790065OtherUNITED CONCORDIA