Healthcare Provider Details

I. General information

NPI: 1306701784
Provider Name (Legal Business Name): ASHTON DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 E IRLO BRONSON HIGHWAY
ST COULD FL
34771
US

IV. Provider business mailing address

4990 E IRLO BRONSON HIGHWAY
ST COULD FL
34771
US

V. Phone/Fax

Practice location:
  • Phone: 689-210-7210
  • Fax: 407-574-4651
Mailing address:
  • Phone: 689-210-7210
  • Fax: 407-574-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER KELLY
Title or Position: OWNER
Credential:
Phone: 407-432-6224