MEDICARE: DR. FLOYD KASCH 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	D4528	OR

General Provider Information

NPI Number	:	1275773038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLOYD KASCH DMD

Provider Business Mailing Address
First Line	:	19265 SE STARK ST
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97233-5758
Country	:	US
Telephone Number	:	503-666-9519
Fax Number	:	503-666-1147

Provider Business Practice Location Address
First Line	:	19265 SE STARK ST
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97233-5758
Country	:	US
Telephone Number	:	503-666-9519
Fax Number	:	503-666-1147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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