Healthcare Provider Details

I. General information

NPI: 1750585774
Provider Name (Legal Business Name): EDWARD D ASDEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 LOMA VISTA RD STE B
VENTURA CA
93003-3047
US

IV. Provider business mailing address

3390 LOMA VISTA RD STE B
VENTURA CA
93003-3047
US

V. Phone/Fax

Practice location:
  • Phone: 805-654-0239
  • Fax:
Mailing address:
  • Phone: 805-654-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number46019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: