MEDICARE: DR. CHARLES PHILIP KASS DDS MS

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	122300000X	Dentist	2901016646	MI

General Provider Information

NPI Number	:	1902968712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES PHILIP KASS DDS MS

Provider Business Mailing Address
First Line	:	4952 SKYVIEW COURT
Second Line	:	SUITE A
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:	231-932-9711
Fax Number	:	231-932-9703

Provider Business Practice Location Address
First Line	:	4952 SKYVIEW COURT
Second Line	:	SUITE A
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684
Country	:	US
Telephone Number	:	231-932-9711
Fax Number	:	231-932-9703

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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