Provider Demographics
NPI:1588952444
Name:LAIRD, ASHLEY (DDS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:LAIRD
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 1:1211 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2118
Mailing Address - Country:US
Mailing Address - Phone:903-593-2313
Mailing Address - Fax:903-597-7033
Practice Address - Street 1:1211 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2118
Practice Address - Country:US
Practice Address - Phone:903-593-2313
Practice Address - Fax:903-597-7033
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice