Provider Demographics
NPI:1235612730
Name:ASADI, SIRAJ K (DMD)
Entity Type:Individual
Prefix:DR
First Name:SIRAJ
Middle Name:K
Last Name:ASADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 NORMANDY BLVD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4861
Mailing Address - Country:US
Mailing Address - Phone:904-781-1201
Mailing Address - Fax:904-903-4540
Practice Address - Street 1:5149 NORMANDY BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4861
Practice Address - Country:US
Practice Address - Phone:904-781-1201
Practice Address - Fax:904-903-4540
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN236981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice