Provider Demographics
NPI:1104122241
Name:ASHRAF A HUSEIN
Entity type:Organization
Organization Name:ASHRAF A HUSEIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-507-1793
Mailing Address - Street 1:2965 NORTH GERMANTOWN ROAD
Mailing Address - Street 2:SUITE #129
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4002
Mailing Address - Country:US
Mailing Address - Phone:901-507-1793
Mailing Address - Fax:901-507-1794
Practice Address - Street 1:2965 NORTH GERMANTOWN ROAD
Practice Address - Street 2:SUITE 129
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4002
Practice Address - Country:US
Practice Address - Phone:901-507-1793
Practice Address - Fax:901-507-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty