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General NPI Number Information
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NPI Number | 1164651295
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Entity Type | Individual
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Provider Name | KEVIN J KASICK
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Gender | Male
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 07/10/2009
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Provider Practice Location Address
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Address Line | 795 N LEXINGTON SPRINGMILL RD
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City | ONTARIO
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State | OH
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Zip | 44906-1114
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Country | US
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Telephone | 419-522-1386
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Fax | 419-775-1119
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone | 315-454-6000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-023050
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License Number State | OH
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