Healthcare Provider Details

I. General information

NPI: 1548524671
Provider Name (Legal Business Name): ASHLEY ROSE LEAVELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 WINCHESTER ST
KEENE NH
03431-3936
US

IV. Provider business mailing address

342 WINCHESTER ST
KEENE NH
03431-3936
US

V. Phone/Fax

Practice location:
  • Phone: 603-352-0502
  • Fax:
Mailing address:
  • Phone: 603-352-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN1856496
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN04041
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: