MEDICARE: SIMON E KASWAN DDS

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	DN16371	FL

General Provider Information

NPI Number	:	1942240221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMON E KASWAN DDS

Provider Business Mailing Address
First Line	:	1021 IVES DAIRY RD, BLDG 3
Second Line	:	SUITE # 121
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179
Country	:	US
Telephone Number	:	305-651-7760
Fax Number	:	305-690-9963

Provider Business Practice Location Address
First Line	:	1021 IVES DAIRY RD
Second Line	:	BLDG 3, SUITE # 121
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-2537
Country	:	US
Telephone Number	:	305-651-7760
Fax Number	:	305-690-9963

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/18/2016

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