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General NPI Number Information
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NPI Number | 1215467576
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Entity Type | Organization
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Legal Business Name | ASHLESON DENTAL CARE, LLC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 104 E OAK ST
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City | GLENWOOD CITY
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State | WI
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Zip | 54013-8582
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Country | US
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Telephone | 715-265-4258
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35
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City | GLENWOOD CITY
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State | WI
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Zip | 54013-0035
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Country | US
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Telephone | 715-265-4258
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Fax | 715-265-4258
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ROCHELLE ASHLESON
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Credential | DDS
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Telephone | 715-688-9619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1001600-15
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License Number State | WI
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