Provider Demographics
NPI:1992994131
Name:WASEF, ASHRAF WASIH TAWFIK
Entity type:Individual
Prefix:
First Name:ASHRAF
Middle Name:WASIH TAWFIK
Last Name:WASEF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 W DIVISION ST
Mailing Address - Street 2:SUITE E0022
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6600
Mailing Address - Country:US
Mailing Address - Phone:320-252-0414
Mailing Address - Fax:320-252-0420
Practice Address - Street 1:4101 W DIVISION ST
Practice Address - Street 2:SUITE E0022
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6600
Practice Address - Country:US
Practice Address - Phone:320-252-0414
Practice Address - Fax:320-252-0420
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice