Provider Demographics
NPI:1871775635
Name:MARTIN, ASHLA (DDS)
Entity type:Individual
Prefix:
First Name:ASHLA
Middle Name:
Last Name:MARTIN
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 1:450 N HIGHWAY 67 STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2136
Mailing Address - Country:US
Mailing Address - Phone:972-291-5720
Mailing Address - Fax:972-291-5730
Practice Address - Street 1:450 N HIGHWAY 67 STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2136
Practice Address - Country:US
Practice Address - Phone:972-291-5720
Practice Address - Fax:972-291-5730
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58731223G0001X
TX252161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5873OtherSTATE LICENSE
TX25216OtherSTATE LICENSE