MEDICARE: ASHMORE DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	63198	CA

General Provider Information

NPI Number	:	1083002463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHMORE DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	4110 W POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5603
Country	:	US
Telephone Number	:	619-701-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 W POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5603
Country	:	US
Telephone Number	:	619-701-6622
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GLENN CASEY ASHMORE
Credential	:	DDS
Telephone Number	:	619-701-6622

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/07/2015

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Directions to “ASHMORE DENTAL CORPORATION ” Practice Location

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