Provider Demographics
NPI:1720342504
Name:MINTEN, ASHLEY ANNE (DDS)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ANNE
Last Name:MINTEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANNE
Other - Last Name:ZOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1155 WITTMANN DR
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-3607
Mailing Address - Country:US
Mailing Address - Phone:920-725-5584
Mailing Address - Fax:
Practice Address - Street 1:1155 WITTMANN DR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-3607
Practice Address - Country:US
Practice Address - Phone:920-725-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6926-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice