Provider Demographics
NPI:1891875514
Name:DE ASIS, REX DATOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:DATOR
Last Name:DE ASIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 RUDDELL RD SE
Mailing Address - Street 2:# UNIT B
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-438-0805
Mailing Address - Fax:360-528-2219
Practice Address - Street 1:5720 RUDDELL RD SE
Practice Address - Street 2:# UNIT B
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-438-0805
Practice Address - Fax:360-528-2219
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist