Provider Demographics
NPI:1851991319
Name:WILDHABER, ASHLEY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:LYNN
Last Name:WILDHABER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:BASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 TUMWATER BLVD SE # 301
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6400
Mailing Address - Country:US
Mailing Address - Phone:360-786-9354
Mailing Address - Fax:
Practice Address - Street 1:111 TUMWATER BLVD SE # 301
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6400
Practice Address - Country:US
Practice Address - Phone:360-786-9354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61085858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1220931301Medicaid