Provider Demographics
NPI:1851730634
Name:TANKERSLEY, ASHLEY CANNON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:CANNON
Last Name:TANKERSLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2350
Mailing Address - Country:US
Mailing Address - Phone:864-268-6417
Mailing Address - Fax:
Practice Address - Street 1:280 ROCKY SLOPE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3908
Practice Address - Country:US
Practice Address - Phone:864-751-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9690DS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery