Provider Demographics
NPI:1659555001
Name:ASON, RAPHAEL ALEJANDRO (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:ALEJANDRO
Last Name:ASON
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3172 BILL BECK BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1608
Mailing Address - Country:US
Mailing Address - Phone:407-483-4939
Mailing Address - Fax:
Practice Address - Street 1:3172 BILL BECK BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1608
Practice Address - Country:US
Practice Address - Phone:407-483-4939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP44962122300000X
FLDN171601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist