Provider Demographics
NPI:1881186625
Name:METCALF, ASHLEY KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:KAY
Last Name:METCALF
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 1:1900 DIVISION ST W UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6397
Mailing Address - Country:US
Mailing Address - Phone:218-333-8832
Mailing Address - Fax:218-333-1352
Practice Address - Street 1:1900 DIVISION ST W UNIT 2
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6397
Practice Address - Country:US
Practice Address - Phone:218-333-8832
Practice Address - Fax:218-333-1352
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND139951223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice