MEDICARE: GHASSAN ASSAF DDS

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	49055	CA

General Provider Information

NPI Number	:	1811101272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHASSAN ASSAF DDS

Provider Business Mailing Address
First Line	:	349 N MYERS ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2115
Country	:	US
Telephone Number	:	818-848-8529
Fax Number	:	818-848-8529

Provider Business Practice Location Address
First Line	:	349 N MYERS ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-2115
Country	:	US
Telephone Number	:	818-848-8529
Fax Number	:	818-848-8529

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	02/04/2008

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