Healthcare Provider Details

I. General information

NPI: 1831261353
Provider Name (Legal Business Name): KESANG DATTA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 S CHURCH ST
HAZLETON PA
18201-6266
US

IV. Provider business mailing address

117 CROOKED STICK LN
HAZLE TOWNSHIP PA
18202-9529
US

V. Phone/Fax

Practice location:
  • Phone: 570-599-8410
  • Fax:
Mailing address:
  • Phone: 917-374-7390
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDI022048
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS042850
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: