Provider Demographics
NPI:1720812175
Name:PRYOR, ASHLEY BETH (RDH, PHDH)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BETH
Last Name:PRYOR
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 N 1160 ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-4143
Mailing Address - Country:US
Mailing Address - Phone:217-690-5161
Mailing Address - Fax:217-235-0801
Practice Address - Street 1:601 E 12TH ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-2335
Practice Address - Country:US
Practice Address - Phone:618-403-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020011667124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist