Provider Demographics
NPI:1215101597
Name:ASHFORD DENTAL INC. II
Entity type:Organization
Organization Name:ASHFORD DENTAL INC. II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-461-0400
Mailing Address - Street 1:101 BECKETT LN
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7155
Mailing Address - Country:US
Mailing Address - Phone:770-461-0400
Mailing Address - Fax:770-461-0280
Practice Address - Street 1:101 BECKETT LN
Practice Address - Street 2:SUITE 403
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7155
Practice Address - Country:US
Practice Address - Phone:770-461-0400
Practice Address - Fax:770-461-0280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHFORD DENTAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty