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General NPI Number Information
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NPI Number | 1124142773
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Entity Type | Individual
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Provider Name | AMANDA GAYNOR ASHLEY DMD, MSEDU, MS
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 234 NATCHEZ TRACE AVE
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7995
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Country | US
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Telephone | 270-715-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 234 NATCHEZ TRACE AVE
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7995
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Country | US
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Telephone | 270-715-5437
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30-023178
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1010
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9425
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9156
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 910
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License Number State | KY
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