MEDICARE: ABENA A ASARE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	24323	TX

General Provider Information

NPI Number	:	1295980530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABENA A ASARE D.D.S.

Provider Business Mailing Address
First Line	:	761 TANK BATTALION BLDG 330
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-4906
Country	:	US
Telephone Number	:	254-285-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 TANK BATTALION BLDG 330
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-4906
Country	:	US
Telephone Number	:	254-285-2014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	06/22/2015

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