Individual
ASHLEY KYLE WASSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
4547 SAINT STEPHENS RD, EIGHT MILE, AL 36613-3563
(251) 456-1399
(251) 456-0079
Mailing address
PO BOX 2867, MOBILE, AL 36652-2867
(251) 690-8158
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
5912
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MAIN GROUP MEDICARE PAYEE NUMBER
AL
01
—
1063439065
NPI MAIN GROUP PAYEE NUMBER
AL
05
—
630000013
—
AL
Enumeration date
04/11/2012
Last updated
07/09/2013
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