Healthcare Provider Details

I. General information

NPI: 1952536583
Provider Name (Legal Business Name): ASHLEY THERESA REED DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E STATE HIGHWAY 54 STE 1
SEYMOUR WI
54165-1904
US

IV. Provider business mailing address

344 E STATE HIGHWAY 54 STE 1
SEYMOUR WI
54165-1904
US

V. Phone/Fax

Practice location:
  • Phone: 920-833-2215
  • Fax: 920-833-9940
Mailing address:
  • Phone: 920-833-2215
  • Fax: 920-833-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6377-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: