Provider Demographics
NPI:1619009156
Name:A ASTRA DENTIST, INC.
Entity Type:Organization
Organization Name:A ASTRA DENTIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KUONG
Authorized Official - Middle Name:C
Authorized Official - Last Name:KOV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-932-9202
Mailing Address - Street 1:1453 N DYSART RD STE B108
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1539
Mailing Address - Country:US
Mailing Address - Phone:623-932-9202
Mailing Address - Fax:
Practice Address - Street 1:1453 N DYSART RD STE B108
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1539
Practice Address - Country:US
Practice Address - Phone:623-932-9202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty