Provider Demographics
NPI:1932690195
Name:ASH, JESSICA ANNA
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANNA
Last Name:ASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNA
Other - Last Name:TINGEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2350 S HIGHWAY 89 APT 17
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-5588
Mailing Address - Country:US
Mailing Address - Phone:435-230-0350
Mailing Address - Fax:
Practice Address - Street 1:169 N GATEWAY DR STE 175
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9825
Practice Address - Country:US
Practice Address - Phone:435-752-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10842218-99221223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice