Provider Demographics
NPI:1902826126
Name:ASH, DONNA ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ANN
Last Name:ASH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 MESQUITE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5783
Mailing Address - Country:US
Mailing Address - Phone:928-505-7300
Mailing Address - Fax:928-505-7357
Practice Address - Street 1:1960 MESQUITE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5783
Practice Address - Country:US
Practice Address - Phone:928-505-7300
Practice Address - Fax:928-505-7357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ792834OtherUNITED CONCORDIA INSURANC