Healthcare Provider Details

I. General information

NPI: 1821381450
Provider Name (Legal Business Name): ASHRAF WASEF DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 2ND ST N STE 201
SAINT CLOUD MN
56303-3237
US

IV. Provider business mailing address

1011 2ND ST N STE 201
SAINT CLOUD MN
56303-3237
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-0414
  • Fax:
Mailing address:
  • Phone: 320-252-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12300
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateMN

VIII. Authorized Official

Name: DR. ASHRAF W WASEF
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 612-735-6545