Healthcare Provider Details

I. General information

NPI: 1659104321
Provider Name (Legal Business Name): ASHLEY ANN BASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 ISLAND AVE STE 2924
PHILADELPHIA PA
19153-2028
US

IV. Provider business mailing address

44 E FAIRVIEW AVE
SELLERSVILLE PA
18960-2611
US

V. Phone/Fax

Practice location:
  • Phone: 215-492-9291
  • Fax:
Mailing address:
  • Phone: 267-450-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH072662
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: