Provider Demographics
NPI:1861842841
Name:COFFEY, ASHLEY (DDS)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:COFFEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1688 PINE ST UNIT W1104
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4875
Mailing Address - Country:US
Mailing Address - Phone:845-233-8987
Mailing Address - Fax:
Practice Address - Street 1:1655 SOUTHGATE AVE STE 200
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2302
Practice Address - Country:US
Practice Address - Phone:650-991-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1053711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery