Provider Demographics
NPI:1134781230
Name:MARTIN, MICHELLE ASHLEY (SA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ASHLEY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 AYERS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4952
Mailing Address - Country:US
Mailing Address - Phone:719-393-3653
Mailing Address - Fax:
Practice Address - Street 1:595 CHAPEL HILLS DR STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1057
Practice Address - Country:US
Practice Address - Phone:719-599-0500
Practice Address - Fax:719-599-0575
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant