Provider Demographics
NPI:1215415047
Name:HASASNEH, ASHRAF
Entity Type:Individual
Prefix:
First Name:ASHRAF
Middle Name:
Last Name:HASASNEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 E LATHAM WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-3010
Mailing Address - Country:US
Mailing Address - Phone:919-702-5193
Mailing Address - Fax:
Practice Address - Street 1:1100 N GATEWAY DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-9600
Practice Address - Country:US
Practice Address - Phone:559-363-4160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1029111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice