Provider Demographics
NPI:1619027893
Name:ASIL, ARASH (DMD)
Entity Type:Individual
Prefix:
First Name:ARASH
Middle Name:
Last Name:ASIL
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 1:390 CAMINO DE ESTRELLA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4859
Mailing Address - Country:US
Mailing Address - Phone:949-481-2000
Mailing Address - Fax:949-481-2411
Practice Address - Street 1:390 CAMINO DE ESTRELLA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4859
Practice Address - Country:US
Practice Address - Phone:949-481-2000
Practice Address - Fax:949-481-2411
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice