Healthcare Provider Details

I. General information

NPI: 1891222816
Provider Name (Legal Business Name): MIDHAT ASFAR DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHN R ST
DETROIT MI
48201-2013
US

IV. Provider business mailing address

24327 HOOVER CT APT 1832
FARMINGTON HILLS MI
48335-2179
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4095
  • Fax:
Mailing address:
  • Phone: 917-972-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901022552
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: