MEDICARE: DEENA KASSAB 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	1223G0001X	General Practice Dentistry	111608	CA

General Provider Information

NPI Number	:	1053202572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEENA KASSAB DMD

Provider Business Mailing Address
First Line	:	1437 W ARROW HWY
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-2331
Country	:	US
Telephone Number	:	909-305-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 W ARROW HWY
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-2331
Country	:	US
Telephone Number	:	909-305-6900
Fax Number	:

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

Provider Enumeration Date	:	07/12/2025
Last Update Date	:	07/12/2025

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