Provider Demographics
NPI:1942458450
Name:RUDISILL, ASHLEY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ANN
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:CRETELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1 MEMORIAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4407
Mailing Address - Country:US
Mailing Address - Phone:864-351-2400
Mailing Address - Fax:864-351-2420
Practice Address - Street 1:1 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4407
Practice Address - Country:US
Practice Address - Phone:864-351-2400
Practice Address - Fax:864-351-2420
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice