Healthcare Provider Details

I. General information

NPI: 1558235515
Provider Name (Legal Business Name): DAVID ASHLEY MD DMD ORAL SURGERY GROUP, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 N MOUND ST STE D
NACOGDOCHES TX
75961-4453
US

IV. Provider business mailing address

511 BROOKWOOD BLVD
BIRMINGHAM AL
35209-6801
US

V. Phone/Fax

Practice location:
  • Phone: 936-564-9401
  • Fax:
Mailing address:
  • Phone: 205-870-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DAVID HOUSTON ASHLEY
Title or Position: MEMBER
Credential: MD, DMD
Phone: 501-208-1593