Healthcare Provider Details

I. General information

NPI: 1851752166
Provider Name (Legal Business Name): AHMAD KASSABJI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N URSULA ST APT# 222
AURORA CO
80045-7419
US

IV. Provider business mailing address

7540 EDNA CT APT 5402
PLANO TX
75024-5868
US

V. Phone/Fax

Practice location:
  • Phone: 315-560-1988
  • Fax:
Mailing address:
  • Phone: 315-560-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number37192
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number00202762
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00202762
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number37192
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: