Provider Demographics
NPI:1255986808
Name:GREEN-SIMS, ASHTON MONIQUE (DMD)
Entity type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:MONIQUE
Last Name:GREEN-SIMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ASHTON
Other - Middle Name:MONIQUE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:9762 APRIL ROSE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46040-8308
Mailing Address - Country:US
Mailing Address - Phone:317-413-3399
Mailing Address - Fax:
Practice Address - Street 1:4939 E 82ND ST STE D500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5678
Practice Address - Country:US
Practice Address - Phone:317-578-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013242A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist