Provider Demographics
NPI:1215174917
Name:SHIRAZ ASIF DDS,LLC
Entity type:Organization
Organization Name:SHIRAZ ASIF DDS,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHIRAZ
Authorized Official - Middle Name:MOHAMMAD
Authorized Official - Last Name:ASIF
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:952-942-0823
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
MND12191261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental