Provider Demographics
NPI:1073725404
Name:LARRY I. KASSEL, DDS, PC
Entity Type:Organization
Organization Name:LARRY I. KASSEL, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:I
Authorized Official - Last Name:KASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-733-8202
Mailing Address - Street 1:1040 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3405
Mailing Address - Country:US
Mailing Address - Phone:810-733-8202
Mailing Address - Fax:810-230-2523
Practice Address - Street 1:1040 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3405
Practice Address - Country:US
Practice Address - Phone:810-733-8202
Practice Address - Fax:810-230-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI128121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty