Provider Demographics
NPI:1558702092
Name:ASH ESTAFAN DDS P.C.
Entity Type:Organization
Organization Name:ASH ESTAFAN DDS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESTAFAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-883-6199
Mailing Address - Street 1:14 VANDERVENTER AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3777
Mailing Address - Country:US
Mailing Address - Phone:516-883-6199
Mailing Address - Fax:
Practice Address - Street 1:14 VANDERVENTER AVE STE 215
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3777
Practice Address - Country:US
Practice Address - Phone:516-883-6199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049384261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental