Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 9342 | KY |
NPI | 1003255878 |
---|---|
Provider Name | Dr. Ashley Rae Mencarelli |
First Address | Lexington, KY 40504-2231 |
Second Address | Lexington, KY 40517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9342 | DENTAL LICENSE NUMBER (01) | KY |