=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841632270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY BREWINGTON LOUDERMILK D.M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2013
-----------------------------------------------------
Last Update Date | 05/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 BREWSTER BLVD
-----------------------------------------------------
City | CAMP LEJEUNE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28547-2575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-450-4740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 941 NEEDLERUSH RD
-----------------------------------------------------
City | SNEADS FERRY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28460-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-312-6590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 38025
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------