MEDICARE: ASRA R JAVEED DMD

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	0401412422	VA

General Provider Information

NPI Number	:	1376787283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASRA R JAVEED DMD

Provider Business Mailing Address
First Line	:	813 BELDOVER CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5923
Country	:	US
Telephone Number	:	347-647-1058
Fax Number	:

Provider Business Practice Location Address
First Line	:	2142 GREAT NECK SQ
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2202
Country	:	US
Telephone Number	:	757-481-3699
Fax Number	:

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	11/02/2011

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