Provider Demographics
NPI:1851426654
Name:JOHN DOUGLAS ASTON D.D.S. P.C.
Entity Type:Organization
Organization Name:JOHN DOUGLAS ASTON D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ASTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-772-6557
Mailing Address - Street 1:1299 CORPORATE DR
Mailing Address - Street 2:SUITE 813
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6621
Mailing Address - Country:US
Mailing Address - Phone:718-772-6557
Mailing Address - Fax:718-569-2636
Practice Address - Street 1:1299 CORPORATE DR
Practice Address - Street 2:SUITE 813
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6621
Practice Address - Country:US
Practice Address - Phone:718-772-6557
Practice Address - Fax:718-569-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049962-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02840068Medicaid