Provider Demographics
NPI:1033871884
Name:ASHRAF, GHOUSIA (DDS)
Entity Type:Individual
Prefix:
First Name:GHOUSIA
Middle Name:
Last Name:ASHRAF
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 1:5401 6TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2618
Mailing Address - Country:US
Mailing Address - Phone:253-759-5437
Mailing Address - Fax:
Practice Address - Street 1:3315 PACIFIC AVE SE STE A1
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2172
Practice Address - Country:US
Practice Address - Phone:360-491-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61178356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist