Provider Demographics
NPI:1366684524
Name:NASIM, ASHKAN ASHTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHKAN
Middle Name:ASHTON
Last Name:NASIM
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 1:176 STEAMBOAT RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1736
Mailing Address - Country:US
Mailing Address - Phone:917-767-3920
Mailing Address - Fax:
Practice Address - Street 1:176 STEAMBOAT RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1736
Practice Address - Country:US
Practice Address - Phone:917-767-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0549711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice