# JACK R. ASHLOCK, DDS PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548309925
- **Authorized official:** DR. JACK R ASHLOCK DDS PS (DENTIST)
- **Authorized official phone:** (509) 327-8681

## Contact information

- **Practice address:** 6821 N COUNTRY HOMES BLVD, STE 202, SPOKANE, WA 99208-4372
- **Practice address phone:** (509) 327-8681
- **Practice address fax:** (509) 327-8562
- **Mailing address:** 12105 N RIVERWOOD DR, SPOKANE, WA 99218-3500
- **Mailing address phone:** (509) 468-2068

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 025103DE00004470 | WA | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5397203 | — | WA |
| 01 | — | 591231 | UNITED CONCORDIA PROVIDER | WA |