Provider Demographics
NPI:1790021061
Name:STEPHEN A. ASAM, D.D.S., P.C.
Entity Type:Organization
Organization Name:STEPHEN A. ASAM, D.D.S., P.C.
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-436-3595
Mailing Address - Street 1:632 CEDAR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8376
Mailing Address - Country:US
Mailing Address - Phone:757-436-3595
Mailing Address - Fax:757-436-3596
Practice Address - Street 1:632 CEDAR RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8376
Practice Address - Country:US
Practice Address - Phone:757-436-3595
Practice Address - Fax:757-436-3596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, P.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-14
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA7311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty