Provider Demographics
NPI:1427116201
Name:TYNAN, ASHLEY C (DMD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:C
Last Name:TYNAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 MALL ROAD, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-647-7600
Mailing Address - Fax:859-647-0213
Practice Address - Street 1:7901 MALL RD STE 200
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1496
Practice Address - Country:US
Practice Address - Phone:859-647-7600
Practice Address - Fax:859-647-0213
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100039560Medicaid