Healthcare Provider Details

I. General information

NPI: 1740365592
Provider Name (Legal Business Name): ANDREW LANCE KASSMAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N. ORACLE ROAD SUITE 327
TUCSON AZ
85704-7740
US

IV. Provider business mailing address

6700 N. ORACLE ROAD SUITE 327
TUCSON AZ
85704-7740
US

V. Phone/Fax

Practice location:
  • Phone: 520-575-1177
  • Fax: 520-297-3328
Mailing address:
  • Phone: 520-575-1177
  • Fax: 520-297-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2495
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: