Provider Demographics
NPI:1184962078
Name:CHANNER, ASHLEY ALEXANDRA KITTO (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ALEXANDRA KITTO
Last Name:CHANNER
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 1:937 E MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5323
Mailing Address - Country:US
Mailing Address - Phone:805-922-4109
Mailing Address - Fax:
Practice Address - Street 1:937 E MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5323
Practice Address - Country:US
Practice Address - Phone:805-922-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist