Provider Demographics
NPI:1063792935
Name:ASTETE, MICHAEL ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ASTETE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18911 NORDHOFF ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3750
Mailing Address - Country:US
Mailing Address - Phone:818-701-5126
Mailing Address - Fax:818-701-5279
Practice Address - Street 1:18911 NORDHOFF ST
Practice Address - Street 2:SUITE 35
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3750
Practice Address - Country:US
Practice Address - Phone:818-701-5126
Practice Address - Fax:818-701-5279
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist