Provider Demographics
NPI:1760423156
Name:IJAZ, ASMA (DDS)
Entity Type:Individual
Prefix:
First Name:ASMA
Middle Name:
Last Name:IJAZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BUCKLAND ST
Mailing Address - Street 2:APT. 1012-2
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-7700
Mailing Address - Country:US
Mailing Address - Phone:860-432-2818
Mailing Address - Fax:860-533-9027
Practice Address - Street 1:521 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1312
Practice Address - Country:US
Practice Address - Phone:203-234-2900
Practice Address - Fax:203-234-3941
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT92521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice