Provider Demographics
NPI:1194286096
Name:ASFOUR, JANEEN WADDAH (DDS)
Entity type:Individual
Prefix:
First Name:JANEEN
Middle Name:WADDAH
Last Name:ASFOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1015
Mailing Address - Country:US
Mailing Address - Phone:413-507-0115
Mailing Address - Fax:
Practice Address - Street 1:1795 MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1015
Practice Address - Country:US
Practice Address - Phone:413-507-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858727122300000X
VA0401417947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist