Provider Demographics
NPI:1457956757
Name:ASHLEY R. TELLO, D.D.S., P.L.L.C.
Entity type:Organization
Organization Name:ASHLEY R. TELLO, D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:TELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-894-1222
Mailing Address - Street 1:1508 CIRCLE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6745
Mailing Address - Country:US
Mailing Address - Phone:817-894-1222
Mailing Address - Fax:
Practice Address - Street 1:101 WESTERN HILLS TRL
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-6701
Practice Address - Country:US
Practice Address - Phone:817-894-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental