Provider Demographics
NPI:1003093246
Name:ASSIOUN, PATRICK FAITHI (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:FAITHI
Last Name:ASSIOUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:FAITHI
Other - Middle Name:PATRICK
Other - Last Name:ASSIOUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:184 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2605
Mailing Address - Country:US
Mailing Address - Phone:508-422-9722
Mailing Address - Fax:
Practice Address - Street 1:184 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2605
Practice Address - Country:US
Practice Address - Phone:508-422-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics