Provider Demographics
NPI:1801518485
Name:SHELLEY, ASHLEY NICOLE (RDH, RDHAP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:RDH, RDHAP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:NOORDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:9453 AVENIDA SAN TIMOTEO
Mailing Address - Street 2:
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92223-4315
Mailing Address - Country:US
Mailing Address - Phone:909-213-7537
Mailing Address - Fax:
Practice Address - Street 1:37 E OLIVE AVE STE A
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5283
Practice Address - Country:US
Practice Address - Phone:909-213-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP886124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist