Provider Demographics
NPI:1336451632
Name:ASAMARAI, MUATH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUATH
Middle Name:A
Last Name:ASAMARAI
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 1:8097 HIGHWAY 65 NE STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4511
Mailing Address - Country:US
Mailing Address - Phone:763-307-8689
Mailing Address - Fax:763-307-8649
Practice Address - Street 1:8097 HIGHWAY 65 NE STE 104
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-4511
Practice Address - Country:US
Practice Address - Phone:763-307-8689
Practice Address - Fax:763-307-8649
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND128861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice