Provider Demographics
NPI:1396063004
Name:ESALA, ANN F (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:F
Last Name:ESALA
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 4TH ST EAST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1903
Mailing Address - Country:US
Mailing Address - Phone:715-685-2200
Mailing Address - Fax:
Practice Address - Street 1:719 MAIN ST E
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1918
Practice Address - Country:US
Practice Address - Phone:715-685-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6210-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist