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General NPI Number Information
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NPI Number | 1750768883
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Entity Type | Organization
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Legal Business Name | CHRISTIANE ASHBA DMD PA PC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 654 PLANK RD
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City | CLIFTON PARK
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State | NY
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Zip | 12065-2019
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Country | US
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Telephone | 518-371-0636
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Fax | 518-688-0151
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Provider Business Mailing Address
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Address Line | 654 PLANK RD
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City | CLIFTON PARK
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State | NY
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Zip | 12065-2019
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Country | US
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Telephone | 518-371-0636
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Fax | 518-688-0151
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTIANE ASHBA
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Credential | DMD
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Telephone | 518-772-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 056496
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License Number State | NY
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