MEDICARE: EDWARD C KASSAB DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS0233445L	PA

General Provider Information

NPI Number	:	1194995746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD C KASSAB DMD

Provider Business Mailing Address
First Line	:	28 N BARBARA ST # AT
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1402
Country	:	US
Telephone Number	:	717-653-2404
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 N BARBARA ST # AT
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1402
Country	:	US
Telephone Number	:	717-653-2404
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD CLIFFE KASSAB
Credential	:
Telephone Number	:	717-653-2404

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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