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General NPI Number Information
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NPI Number | 1790021061
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Entity Type | Organization
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Legal Business Name | STEPHEN A. ASAM, D.D.S., P.C.
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 632 CEDAR RD SUITE A
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8376
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Country | US
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Telephone | 757-436-3595
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Fax | 757-436-3596
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Provider Business Mailing Address
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Address Line | 632 CEDAR RD SUITE A
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8376
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Country | US
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Telephone | 757-436-3595
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Fax | 757-436-3596
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Authorized Official
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Title or Position | DENTIST
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Name | DR. STEPHEN A ASAM
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Credential | D.D.S.
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Telephone | 757-436-3595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7311
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License Number State | VA
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