Healthcare Provider Details

I. General information

NPI: 1144881533
Provider Name (Legal Business Name): ASHLEY RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 N GREEN MOUNT RD STE B
O FALLON IL
62269-3484
US

IV. Provider business mailing address

1490 N GREEN MOUNT RD STE B
O FALLON IL
62269-3484
US

V. Phone/Fax

Practice location:
  • Phone: 618-591-1582
  • Fax:
Mailing address:
  • Phone: 618-591-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.036973
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2019023334
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: