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NPI Code Detail

MEDICARE: DR. RANDAN LUDLOW ASHMORE DMD

MEDICARE: DR. RANDAN LUDLOW ASHMORE DMD
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
11223E0200XEndodonticsDN008320GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DN008320OTHERGADENTAL LISCENCE

General Provider Information

NPI Number : 1780721217
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDAN LUDLOW ASHMORE DMD
Provider Business Mailing Address
First Line : 1010 PRINCE AVE
Second Line :
City : ATHENS
State : GA
Zip : 30606-5805
Country : US
Telephone Number : 706-546-1241
Fax Number : 706-546-1242
Provider Business Practice Location Address
First Line : 1010 PRINCE AVE
Second Line :
City : ATHENS
State : GA
Zip : 30606-5805
Country : US
Telephone Number : 706-546-1241
Fax Number : 706-546-1242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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