Provider Demographics
NPI:1881203974
Name:ASHTON, BRYCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:ASHTON
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 1:3453 BROOKSIDE RD STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1788
Mailing Address - Country:US
Mailing Address - Phone:209-955-1500
Mailing Address - Fax:
Practice Address - Street 1:3453 BROOKSIDE RD STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-1788
Practice Address - Country:US
Practice Address - Phone:209-955-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200224231223G0001X
KS617231223G0001X
CA1070561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice