Provider Demographics
NPI:1053753772
Name:WICKWIRE, ASHTON (DDS)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:WICKWIRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1457
Mailing Address - Country:US
Mailing Address - Phone:608-723-2141
Mailing Address - Fax:
Practice Address - Street 1:100 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1724
Practice Address - Country:US
Practice Address - Phone:641-872-2514
Practice Address - Fax:641-872-1152
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS090241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice