Provider Demographics
NPI:1821381450
Name:ASHRAF WASEF DDS, PA
Entity Type:Organization
Organization Name:ASHRAF WASEF DDS, PA
Other - Org Name:SMILE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:W
Authorized Official - Last Name:WASEF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-735-6545
Mailing Address - Street 1:1011 2ND ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-3237
Mailing Address - Country:US
Mailing Address - Phone:320-252-0414
Mailing Address - Fax:
Practice Address - Street 1:1011 2ND ST N STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-3237
Practice Address - Country:US
Practice Address - Phone:320-252-0414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123001223G0001X
124Q00000X
MN126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN91610700Medicaid
MN1992994131OtherPERSONAL NPI#