Provider Demographics
NPI:1053587097
Name:ASFOUR, GHASSAN G (DDS)
Entity type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:G
Last Name:ASFOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:G JULIEN
Other - Middle Name:
Other - Last Name:ASFOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:654 MADISON AVE
Mailing Address - Street 2:SUITE 904
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8404
Mailing Address - Country:US
Mailing Address - Phone:212-421-4485
Mailing Address - Fax:
Practice Address - Street 1:654 MADISON AVE
Practice Address - Street 2:SUITE 904
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8404
Practice Address - Country:US
Practice Address - Phone:212-421-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist