Provider Demographics
NPI:1245551738
Name:ELIZONDO, ASHLEY ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ROSE
Last Name:ELIZONDO
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 1:3707 MORNING MIST ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2117
Mailing Address - Country:US
Mailing Address - Phone:210-386-6727
Mailing Address - Fax:
Practice Address - Street 1:5601 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1979
Practice Address - Country:US
Practice Address - Phone:210-521-1733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0025544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist