Provider Demographics
NPI:1962053157
Name:PETERSOHN, ASHLEY ANNE GLAZIER (RDH, MA,BA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANNE GLAZIER
Last Name:PETERSOHN
Suffix:
Gender:F
Credentials:RDH, MA,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 MANHATTAN DR APT 201
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4052
Mailing Address - Country:US
Mailing Address - Phone:303-819-4884
Mailing Address - Fax:
Practice Address - Street 1:2111 CHAMPA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2529
Practice Address - Country:US
Practice Address - Phone:303-293-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002025554124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist