Provider Demographics
NPI:1134794654
Name:LOENSER, ASHLYNN NICOLE
Entity type:Individual
Prefix:
First Name:ASHLYNN
Middle Name:NICOLE
Last Name:LOENSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11470 PATTERSON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9748
Mailing Address - Country:US
Mailing Address - Phone:269-357-4902
Mailing Address - Fax:
Practice Address - Street 1:2429 ELLSWORTH RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4853
Practice Address - Country:US
Practice Address - Phone:734-434-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600936APP211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice