Healthcare Provider Details

I. General information

NPI: 1700352689
Provider Name (Legal Business Name): ASMA HUSIENZAD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 SW 2ND ST
BEAVERTON OR
97005-2708
US

IV. Provider business mailing address

335 NICHOLSON RD
MOUNT EPHRAIM NJ
08059-1948
US

V. Phone/Fax

Practice location:
  • Phone: 503-664-9953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12254
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: