Provider Demographics
NPI: | 1467180182 |
---|---|
Name: | AASDG PLLC |
Entity type: | Organization |
Organization Name: | AASDG PLLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSHUA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BRASHER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 405-474-6362 |
Mailing Address - Street 1: | 13420 N PENNSYLVANIA AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | OKLAHOMA CITY |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73120-9007 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 405-418-0888 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 13400 N PENNSYLVANIA AVE |
Practice Address - Street 2: | |
Practice Address - City: | OKLAHOMA CITY |
Practice Address - State: | OK |
Practice Address - Zip Code: | 73120-9007 |
Practice Address - Country: | US |
Practice Address - Phone: | 405-418-0888 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-08-10 |
Last Update Date: | 2024-09-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |
No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental | Group - Single Specialty |