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General NPI Number Information
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NPI Number | 1215424353
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Entity Type | Individual
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Provider Name | ASHLEY ELIZABETH WILSON DENTAL HYGIENIST
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Gender | Female
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 04/14/2018
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Provider Practice Location Address
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Address Line | 1079 SPACE CENTER DR UNIT 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80915-3612
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Country | US
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Telephone | 719-596-3481
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Fax |
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Provider Business Mailing Address
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Address Line | 7558 FOREST VALLEY LOOP
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City | COLORADO SPRINGS
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State | CO
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Zip | 80908-5647
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Country | US
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Telephone | 757-351-9180
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH.002024806
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License Number State | CO
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