Healthcare Provider Details

I. General information

NPI: 1053654038
Provider Name (Legal Business Name): ASHLEY ZEIGLER DENTAL HYGENTIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SOUTHLAND DR
SIKESTON MO
63801-4403
US

IV. Provider business mailing address

420 LINE ST P O BOX 400
NEW MADRID MO
63869-1734
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-4167
  • Fax: 573-471-4212
Mailing address:
  • Phone: 573-748-2404
  • Fax: 573-748-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2005005663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: