Provider Demographics
NPI:1902297633
Name:DR.S ASHLEY AND ROUCH, LLP
Entity Type:Organization
Organization Name:DR.S ASHLEY AND ROUCH, LLP
Other - Org Name:FRANKLIN STREET DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-424-6761
Mailing Address - Street 1:2300 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-5119
Mailing Address - Country:US
Mailing Address - Phone:812-424-6761
Mailing Address - Fax:
Practice Address - Street 1:2300 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-5119
Practice Address - Country:US
Practice Address - Phone:812-424-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty