Provider Demographics
NPI:1720195084
Name:ASAAD, MAHER BOTROS SR (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAHER
Middle Name:BOTROS
Last Name:ASAAD
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 N VENTURA RD #A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030
Mailing Address - Country:US
Mailing Address - Phone:805-988-4540
Mailing Address - Fax:805-988-4778
Practice Address - Street 1:712 N VENTURA RD #A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:805-988-4540
Practice Address - Fax:805-988-4778
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA516510Medicare ID - Type Unspecified