Healthcare Provider Details

I. General information

NPI: 1003255878
Provider Name (Legal Business Name): ASHLEY RAE MENCARELLI DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 FEHL LN
CINCINNATI OH
45230-4349
US

IV. Provider business mailing address

1163 FEHL LN
CINCINNATI OH
45230-4349
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-0041
  • Fax:
Mailing address:
  • Phone: 513-231-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9342
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.025505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: