Provider Demographics
NPI:1346082500
Name:ASHLEY HUMLICEK DDS PA
Entity type:Organization
Organization Name:ASHLEY HUMLICEK DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMLICEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:701-367-9982
Mailing Address - Street 1:10924 W HAMPTON LAKES CT
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-3778
Mailing Address - Country:US
Mailing Address - Phone:701-367-9982
Mailing Address - Fax:
Practice Address - Street 1:13211 W 21ST CT. N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235
Practice Address - Country:US
Practice Address - Phone:316-945-8367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty