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General NPI Number Information
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NPI Number | 1932581246
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Entity Type | Organization
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Legal Business Name | MATTHEW I KESSMAN DDS PC
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 8604 GRAND AVE STE L2
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City | ELMHURST
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State | NY
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Zip | 11373-8803
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Country | US
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Telephone | 718-335-4980
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Fax | 718-565-1245
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Provider Business Mailing Address
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Address Line | 8604 GRAND AVE STE L2
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City | ELMHURST
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State | NY
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Zip | 11373-8803
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Country | US
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Telephone | 718-335-4980
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Fax | 718-565-1245
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE B KESSMAN
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Credential | DMD
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Telephone | 718-335-4980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23620
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License Number State | NY
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