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General NPI Number Information
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NPI Number | 1679656979
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Entity Type | Organization
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Legal Business Name | CHARLES A. KASS DDS,MS,SC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 12720 W NORTH AVE
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City | BROOKFIELD
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State | WI
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Zip | 53005-4637
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Country | US
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Telephone | 262-784-7680
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Fax | 262-784-7688
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Provider Business Mailing Address
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Address Line | 12720 W NORTH AVE
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City | BROOKFIELD
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State | WI
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Zip | 53005-4637
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Country | US
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Telephone | 262-784-7680
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Fax | 262-784-7688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES A KASS
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Credential | D.D.S.
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Telephone | 262-784-7680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 5000531015
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License Number State | WI
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