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General NPI Number Information
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NPI Number | 1962573816
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Entity Type | Individual
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Provider Name | BILAL KASSAK DMD
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 1518 WALNUT ST STE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3403
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Country | US
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Telephone | 215-317-7625
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Fax | 215-772-0271
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Provider Business Mailing Address
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Address Line | 1518 WALNUT ST STE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3403
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Country | US
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Telephone | 215-317-7625
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Fax | 215-772-0271
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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 | DS031403-L
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License Number State | PA
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