Provider Demographics
NPI:1073564142
Name:KASSOY, GERALD H (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:H
Last Name:KASSOY
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:377 S ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-1831
Mailing Address - Country:US
Mailing Address - Phone:614-235-9931
Mailing Address - Fax:614-575-2252
Practice Address - Street 1:1418 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2397
Practice Address - Country:US
Practice Address - Phone:614-575-2225
Practice Address - Fax:614-575-2252
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH149001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398627Medicaid
OH310961704-026OtherCARESOURCE