Healthcare Provider Details

I. General information

NPI: 1902237555
Provider Name (Legal Business Name): ASHLEY PRESHONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 LIBERTY LN UNIT 117
SOUTH PORTLAND ME
04106-2090
US

IV. Provider business mailing address

41 LIBERTY LN UNIT 117
SOUTH PORTLAND ME
04106-2090
US

V. Phone/Fax

Practice location:
  • Phone: 207-592-2127
  • Fax:
Mailing address:
  • Phone: 207-592-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH3873
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: