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NPI Code Detail

MEDICARE: ASHLEY KYLE WASSERMAN D.M.D

MEDICARE: ASHLEY KYLE WASSERMAN D.M.D
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223D0001XPublic Health Dentistry5912AL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2011846OTHERALMAIN GROUP MEDICARE PAYEE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31063439065OTHERALNPI MAIN GROUP PAYEE NUMBER

General Provider Information

NPI Number : 1700142015
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY KYLE WASSERMAN D.M.D
Provider Business Mailing Address
First Line : PO BOX 2867
Second Line :
City : MOBILE
State : AL
Zip : 36652-2867
Country : US
Telephone Number : 251-690-8158
Fax Number :
Provider Business Practice Location Address
First Line : 4547 SAINT STEPHENS RD
Second Line :
City : EIGHT MILE
State : AL
Zip : 36613-3563
Country : US
Telephone Number : 251-456-1399
Fax Number : 251-456-0079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2012
Last Update Date : 07/09/2013

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