Provider Demographics
NPI:1427416163
Name:VERBICK, ASHLEY MARIE (DMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:VERBICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MARIE
Other - Last Name:LITZENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12180 BUSINESS PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-4525
Mailing Address - Country:US
Mailing Address - Phone:763-421-5206
Mailing Address - Fax:763-421-8320
Practice Address - Street 1:12180 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-4525
Practice Address - Country:US
Practice Address - Phone:763-421-5206
Practice Address - Fax:763-421-8320
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND137901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice