Healthcare Provider Details

I. General information

NPI: 1861541518
Provider Name (Legal Business Name): DR. ASHRAF W SEDHOM-BDS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11246 E MISSISSIPPI AVE
AURORA CO
80012-3202
US

IV. Provider business mailing address

11246 E MISSISSIPPI AVE
AURORA CO
80012-3202
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-0810
  • Fax: 303-344-5309
Mailing address:
  • Phone: 303-344-0810
  • Fax: 303-344-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6616
License Number StateCO

VIII. Authorized Official

Name: ASHRAF W SEDHOM
Title or Position: ORAL SURGEON
Credential: M.D.
Phone: 303-344-0810