Healthcare Provider Details

I. General information

NPI: 1770337461
Provider Name (Legal Business Name): DAVID ASHLEY MD DMD ORAL SURGERY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 S COLLEGE RD STE 108
LAFAYETTE LA
70503-3061
US

IV. Provider business mailing address

511 BROOKWOOD BLVD
HOMEWOOD AL
35209-6801
US

V. Phone/Fax

Practice location:
  • Phone: 337-541-2260
  • Fax: 337-541-2270
Mailing address:
  • Phone: 205-870-1009
  • 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: DR. DAVID HOUSTON ASHLEY
Title or Position: PRINCIPAL
Credential: MD, DMD
Phone: 205-870-1009