Healthcare Provider Details

I. General information

NPI: 1528158946
Provider Name (Legal Business Name): KASSIE OUBRE HSU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 FAIRVIEW RD SUITE 200
CHARLOTTE NC
28210-3393
US

IV. Provider business mailing address

6849 FAIRVIEW RD SUITE 200
CHARLOTTE NC
28210-3393
US

V. Phone/Fax

Practice location:
  • Phone: 704-364-4711
  • Fax:
Mailing address:
  • Phone: 704-364-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9468
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: