1659304376 NPI number — WYLENE ASHLEY DENTAL HYGIENIST

Table of content: WYLENE ASHLEY DENTAL HYGIENIST (NPI 1659304376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659304376 NPI number — WYLENE ASHLEY DENTAL HYGIENIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASHLEY
Provider First Name:
WYLENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DENTAL HYGIENIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASHLEY
Provider Other First Name:
WYLENE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DENTAL HYGIENIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659304376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10200 SW 140TH ST
Provider Second Line Business Mailing Address:
10200 SW 140TH STREET
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33176-6663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-232-9446
Provider Business Mailing Address Fax Number:
305-575-3373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 NW 16H ST.
Provider Second Line Business Practice Location Address:
1201 NW 16 ST.
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-575-3146
Provider Business Practice Location Address Fax Number:
305-575-3373
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  DH06967 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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