Healthcare Provider Details

I. General information

NPI: 1043152275
Provider Name (Legal Business Name): DAVID ASHLEY MD DMD ORAL SURGERY GROUP, A PROFESSIONAL DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 28TH AVE
PINE BLUFF AR
71603-4726
US

IV. Provider business mailing address

813 SHADES CREEK PKWY STE 205
BIRMINGHAM AL
35209-4512
US

V. Phone/Fax

Practice location:
  • Phone: 337-541-2260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DAVID HOUSTON ASHLEY
Title or Position: MEMBER
Credential: MD, DMD
Phone: 501-208-1593