Provider Demographics
NPI:1588110464
Name:ASHLEY S. TERCERO, D.D.S., P.L.L.C.
Entity type:Organization
Organization Name:ASHLEY S. TERCERO, D.D.S., P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:STORMO
Authorized Official - Last Name:TERCERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-834-2004
Mailing Address - Street 1:3909 CREEKSIDE LOOP
Mailing Address - Street 2:SUITE #140
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4880
Mailing Address - Country:US
Mailing Address - Phone:509-834-2004
Mailing Address - Fax:509-834-2007
Practice Address - Street 1:3909 CREEKSIDE LOOP
Practice Address - Street 2:SUITE #140
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4880
Practice Address - Country:US
Practice Address - Phone:509-834-2004
Practice Address - Fax:509-834-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000112421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty