Provider Demographics
NPI:1205984044
Name:ASHY, SUSAN RENELL (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RENELL
Last Name:ASHY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:YARBROUGH
Other - Last Name:ASHY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2450 FONDREN RD.
Mailing Address - Street 2:STE.250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063
Mailing Address - Country:US
Mailing Address - Phone:713-266-5773
Mailing Address - Fax:713-782-5747
Practice Address - Street 1:2450 FONDREN RD
Practice Address - Street 2:STE.250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2318
Practice Address - Country:US
Practice Address - Phone:713-266-5773
Practice Address - Fax:713-782-5747
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice