Provider Demographics
NPI:1407699358
Name:DIRKSEN, ASHLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:DIRKSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 LEGION DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-1729
Mailing Address - Country:US
Mailing Address - Phone:320-226-1871
Mailing Address - Fax:
Practice Address - Street 1:629 LEGION DR STE 2
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1729
Practice Address - Country:US
Practice Address - Phone:320-269-6416
Practice Address - Fax:320-269-8136
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND1051001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice