Provider Demographics
NPI:1215009477
Name:ASIF, SHIRAZ MOHAMMAD (BDS)
Entity type:Individual
Prefix:
First Name:SHIRAZ
Middle Name:MOHAMMAD
Last Name:ASIF
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:MOHAMMAD
Other - Middle Name:SHIRAZ
Other - Last Name:ASIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8775 COLUMBINE RD
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-6695
Mailing Address - Country:US
Mailing Address - Phone:952-942-0823
Mailing Address - Fax:952-224-2986
Practice Address - Street 1:8775 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-6695
Practice Address - Country:US
Practice Address - Phone:952-942-0823
Practice Address - Fax:952-224-2986
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND121911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice