Provider Demographics
NPI:1023610839
Name:DAVIDSON, ASHLEY (RDH)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14246 MADRIGAL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5955
Mailing Address - Country:US
Mailing Address - Phone:141-946-3763
Mailing Address - Fax:
Practice Address - Street 1:8998 LORTON STATION BLVD STE E
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4790
Practice Address - Country:US
Practice Address - Phone:703-339-3898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402205509124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty