Provider Demographics
NPI:1861541518
Name:DR. ASHRAF W SEDHOM-BDS MD PC
Entity type:Organization
Organization Name:DR. ASHRAF W SEDHOM-BDS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEDHOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-344-0810
Mailing Address - Street 1:11246 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3202
Mailing Address - Country:US
Mailing Address - Phone:303-344-0810
Mailing Address - Fax:303-344-5309
Practice Address - Street 1:11246 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3202
Practice Address - Country:US
Practice Address - Phone:303-344-0810
Practice Address - Fax:303-344-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO66161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34278052Medicaid
CO02066165Medicaid