Healthcare Provider Details

I. General information

NPI: 1932690195
Provider Name (Legal Business Name): DR. JESSICA ANNA ASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANNA TINGEY DDS

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N GATEWAY DR STE 175
PROVIDENCE UT
84332-9825
US

IV. Provider business mailing address

2350 S HIGHWAY 89 APT 17
PERRY UT
84302-5588
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-0605
  • Fax:
Mailing address:
  • Phone: 435-230-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10842218-9922
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10842218-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: