Provider Demographics
NPI:1073185625
Name:ASHOUR, IZOH (DDSM MS)
Entity Type:Individual
Prefix:DR
First Name:IZOH
Middle Name:
Last Name:ASHOUR
Suffix:
Gender:M
Credentials:DDSM MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 BROCKS WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3442
Mailing Address - Country:US
Mailing Address - Phone:410-446-0475
Mailing Address - Fax:
Practice Address - Street 1:12301 NE 10TH PL STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2487
Practice Address - Country:US
Practice Address - Phone:425-428-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61162299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty