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General NPI Number Information
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NPI Number | 1538814769
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Entity Type | Individual
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Provider Name | ASHLEY LORAN CONLEY-FASONE DMD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 8418 NEW TOWN RD
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City | WAXHAW
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State | NC
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Zip | 28173-8302
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Country | US
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Telephone | 47-843-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 6555 KINDER LN
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City | LANCASTER
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State | SC
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Zip | 29720-0405
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10190
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License Number State | SC
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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 | 12834
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License Number State | NC
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