Provider Demographics
NPI:1376972554
Name:ASON MAXILLOFACIAL SURGERY, PA
Entity Type:Organization
Organization Name:ASON MAXILLOFACIAL SURGERY, PA
Other - Org Name:KISSIMMEE ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:ASON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MD
Authorized Official - Phone:407-483-4939
Mailing Address - Street 1:3172 BILL BECK BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1608
Mailing Address - Country:US
Mailing Address - Phone:407-483-4939
Mailing Address - Fax:407-483-4941
Practice Address - Street 1:3172 BILL BECK BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1608
Practice Address - Country:US
Practice Address - Phone:407-483-4939
Practice Address - Fax:407-483-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty