Provider Demographics
NPI:1366002875
Name:ASADI, MICAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:ASADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9594 POTRANCO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-9619
Mailing Address - Country:US
Mailing Address - Phone:210-523-2323
Mailing Address - Fax:
Practice Address - Street 1:9594 POTRANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9618
Practice Address - Country:US
Practice Address - Phone:210-523-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK71901223G0001X
TX351451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice