Provider Demographics
NPI:1215467576
Name:ASHLESON DENTAL CARE, LLC
Entity type:Organization
Organization Name:ASHLESON DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHLESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-688-9619
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54013-0035
Mailing Address - Country:US
Mailing Address - Phone:715-265-4258
Mailing Address - Fax:715-265-4258
Practice Address - Street 1:104 E OAK ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD CITY
Practice Address - State:WI
Practice Address - Zip Code:54013-8582
Practice Address - Country:US
Practice Address - Phone:715-265-4258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001600-15261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental