Provider Demographics
NPI:1659314888
Name:AFSHAR, ANDREW A (DDS, MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:A
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 MERLIN CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-7358
Mailing Address - Country:US
Mailing Address - Phone:989-839-9979
Mailing Address - Fax:989-839-9553
Practice Address - Street 1:6112 MERLIN CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7358
Practice Address - Country:US
Practice Address - Phone:989-839-9979
Practice Address - Fax:989-839-9553
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND19461223S0112X
MI2901022525204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1946OtherDENTAL LICENSE
ND41322Medicaid