Healthcare Provider Details

I. General information

NPI: 1699475616
Provider Name (Legal Business Name): ADHM H ASFAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CENTRAL AVE NW STE F1
ALBUQUERQUE NM
87105-1669
US

IV. Provider business mailing address

115 S 38TH ST APT 281
COUNCIL BLUFFS IA
51501-3390
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-7172
  • Fax:
Mailing address:
  • Phone: 505-331-8401
  • 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 Code122300000X
TaxonomyDentist
License NumberDB-2023-0080
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: