Provider Demographics
NPI:1356635734
Name:ASHRAFI, JERRY (DMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:ASHRAFI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W END AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4917
Mailing Address - Country:US
Mailing Address - Phone:617-910-7106
Mailing Address - Fax:
Practice Address - Street 1:180 W END AVE APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4917
Practice Address - Country:US
Practice Address - Phone:212-362-5517
Practice Address - Fax:212-787-9588
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY056125-011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program