Provider Demographics
NPI:1962239442
Name:ASHFORD, MALLORI (DDS)
Entity type:Individual
Prefix:DR
First Name:MALLORI
Middle Name:
Last Name:ASHFORD
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 1:101 BECKETT LN STE 404
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7159
Mailing Address - Country:US
Mailing Address - Phone:404-451-0559
Mailing Address - Fax:770-461-0400
Practice Address - Street 1:101 BECKETT LN STE 404
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7159
Practice Address - Country:US
Practice Address - Phone:770-461-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1236061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice