Provider Demographics
NPI:1073558631
Name:ESTAFAN, ASHRAF M (DDS)
Entity type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:M
Last Name:ESTAFAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 VANDERVENTER AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3759
Mailing Address - Country:US
Mailing Address - Phone:516-883-6199
Mailing Address - Fax:516-883-6959
Practice Address - Street 1:14 VANDERVENTER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3759
Practice Address - Country:US
Practice Address - Phone:516-883-6199
Practice Address - Fax:516-883-6959
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049384122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist