Provider Demographics
NPI:1457910234
Name:ASHTON, KELSEA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEA
Middle Name:
Last Name:ASHTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LYNDSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-2332
Mailing Address - Country:US
Mailing Address - Phone:618-967-2729
Mailing Address - Fax:
Practice Address - Street 1:115 LYNDSEY LN
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-2332
Practice Address - Country:US
Practice Address - Phone:618-967-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist