Provider Demographics
NPI:1699475616
Name:ASFAN, ADHM H (DDS)
Entity type:Individual
Prefix:
First Name:ADHM
Middle Name:H
Last Name:ASFAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S 38TH ST APT 281
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3390
Mailing Address - Country:US
Mailing Address - Phone:505-331-8401
Mailing Address - Fax:
Practice Address - Street 1:4201 CENTRAL AVE NW STE F1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1669
Practice Address - Country:US
Practice Address - Phone:505-843-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NMDB-2023-0080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program