Provider Demographics
NPI:1891223913
Name:ANDERSON, ASHLEY REBECCA (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:REBECCA
Last Name:ANDERSON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:577-668-7713
Mailing Address - Fax:757-668-7711
Practice Address - Street 1:301 RIVERVIEW AVE STE 300
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1066
Practice Address - Country:US
Practice Address - Phone:757-668-7713
Practice Address - Fax:757-668-7711
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014156451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program