Provider Demographics
NPI:1295046795
Name:MANLOVE, ASHLEY E (DMD, MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:MANLOVE
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:149 BRAUER HALL CB 7450
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-2500
Practice Address - Country:US
Practice Address - Phone:919-537-3944
Practice Address - Fax:919-537-3407
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-02223204E00000X
NC139141223S0112X
FLME122828204E00000X
IL021002737204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003163495AMedicaid
FL014932200Medicaid
NC204E00000XMedicaid
NC1223S0112XMedicaid