Provider Demographics
NPI:1083740294
Name:KASSOLIS, ALEXANDER RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:RICHARD
Last Name:KASSOLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1822
Mailing Address - Country:US
Mailing Address - Phone:410-944-4695
Mailing Address - Fax:410-944-4713
Practice Address - Street 1:2108 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1822
Practice Address - Country:US
Practice Address - Phone:410-944-4695
Practice Address - Fax:410-944-4713
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD044811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice