Provider Demographics
NPI:1508316902
Name:DR ASHRAF W SEDHOM BDS MD PC
Entity Type:Organization
Organization Name:DR ASHRAF W SEDHOM BDS MD PC
Other - Org Name:SANTA FE ORAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-344-0810
Mailing Address - Street 1:2210 S FEDERAL BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-5482
Mailing Address - Country:US
Mailing Address - Phone:303-936-5922
Mailing Address - Fax:303-936-5962
Practice Address - Street 1:2210 S FEDERAL BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-5482
Practice Address - Country:US
Practice Address - Phone:303-936-5922
Practice Address - Fax:303-936-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02066165Medicaid
CO34278052Medicaid