Provider Demographics
NPI:1386192011
Name:ASE DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:ASE DENTAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHARLAND BASSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-593-5500
Mailing Address - Street 1:10301 GEORGIA AVE STE 207
Mailing Address - Street 2:SILVER SPRING, MD 20902
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-593-5500
Mailing Address - Fax:
Practice Address - Street 1:10301 GEORGIA AVE STE 207
Practice Address - Street 2:SILVER SPRING, MD 20902
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-593-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12137122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty