Provider Demographics
NPI:1730596230
Name:SMITH, ASHLEY F
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:F
Last Name:SMITH
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 1:101 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-4520
Mailing Address - Country:US
Mailing Address - Phone:630-881-9273
Mailing Address - Fax:
Practice Address - Street 1:2 E 22ND ST STE 201
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6105
Practice Address - Country:US
Practice Address - Phone:630-627-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020013002124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist