Provider Demographics
NPI:1962011817
Name:MASAK, ATEF MONIER REZK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ATEF
Middle Name:MONIER REZK
Last Name:MASAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 SE HONEYSUCKLE LOOP UNIT B
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-7399
Mailing Address - Country:US
Mailing Address - Phone:201-618-2036
Mailing Address - Fax:
Practice Address - Street 1:433 30TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-2807
Practice Address - Country:US
Practice Address - Phone:503-338-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61084201122300000X
ORD11273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist