MEDICARE: DR. JUSTIN SCOTT ASHTON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25484	TX

General Provider Information

NPI Number	:	1831410281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN SCOTT ASHTON D.D.S.

Provider Business Mailing Address
First Line	:	4552 HICKORY MEADOWS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5847
Country	:	US
Telephone Number	:	817-562-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 NE MALL BLVD
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-4653
Country	:	US
Telephone Number	:	817-595-9675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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