Provider Demographics
NPI:1174235311
Name:RIDILLA, ASHLEY (RDH)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RIDILLA
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 1:11744 QUAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1270
Mailing Address - Country:US
Mailing Address - Phone:570-417-1614
Mailing Address - Fax:
Practice Address - Street 1:1062 AKRON WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7102
Practice Address - Country:US
Practice Address - Phone:303-365-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist