Healthcare Provider Details

I. General information

NPI: 1346345873
Provider Name (Legal Business Name): LOUIS KASSAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163-01 DEPOT RD
FLUSHING NY
11358-2078
US

IV. Provider business mailing address

163-01 DEPOT RD
FLUSHING NY
11358-2078
US

V. Phone/Fax

Practice location:
  • Phone: 718-539-1526
  • Fax: 718-539-1862
Mailing address:
  • Phone: 718-539-1526
  • Fax: 718-539-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50021099
License Number StateNY

VIII. Authorized Official

Name: DR. LOUIS KASSAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 718-539-1526