Healthcare Provider Details

I. General information

NPI: 1467396747
Provider Name (Legal Business Name): ASHLEY C BODART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 ROUTE 3 NORTH SUITE 201
GAMBRILLS MD
21054
US

IV. Provider business mailing address

1231 BALIOL LN
ODENTON MD
21113-1838
US

V. Phone/Fax

Practice location:
  • Phone: 443-300-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7887
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: