Provider Demographics
NPI:1962177907
Name:ASFOUR, PAUL JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:ASFOUR
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 1:7350 SKYLINE VISTA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-5265
Mailing Address - Country:US
Mailing Address - Phone:206-922-9709
Mailing Address - Fax:
Practice Address - Street 1:9800 W SKYE CANYON PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-6630
Practice Address - Country:US
Practice Address - Phone:702-899-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV7583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program