Provider Demographics
NPI:1124611215
Name:THOMAS, ASHLEY NOELLE (RDH)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NOELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6281
Mailing Address - Country:US
Mailing Address - Phone:916-582-0723
Mailing Address - Fax:
Practice Address - Street 1:519 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6281
Practice Address - Country:US
Practice Address - Phone:916-582-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4465124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist