Healthcare Provider Details

I. General information

NPI: 1821462821
Provider Name (Legal Business Name): SYED HUSAIN ASGHAR MD, DMD, BDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2015
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4823 MEADOWS RD STE 131
LAKE OSWEGO OR
97035-2622
US

IV. Provider business mailing address

502 SW 200TH AVE
BEAVERTON OR
97006-1406
US

V. Phone/Fax

Practice location:
  • Phone: 503-334-0351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE61549419
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD11752
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: