Provider Demographics
NPI:1548610983
Name:ASHA, KOUROSH (DMD)
Entity Type:Individual
Prefix:
First Name:KOUROSH
Middle Name:
Last Name:ASHA
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 1:42 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2106
Mailing Address - Country:US
Mailing Address - Phone:781-346-4298
Mailing Address - Fax:
Practice Address - Street 1:42 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2106
Practice Address - Country:US
Practice Address - Phone:603-778-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice