Provider Demographics
NPI:1669908216
Name:POWELL, ASHLEY NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NICOLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:NORVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3206 LANGLEY DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6020
Mailing Address - Country:US
Mailing Address - Phone:501-268-2000
Mailing Address - Fax:501-268-2442
Practice Address - Street 1:3206 LANGLEY DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6020
Practice Address - Country:US
Practice Address - Phone:501-268-2000
Practice Address - Fax:501-268-2442
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR41561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221305608Medicaid