Provider Demographics
NPI:1346368867
Name:KESSMAN, MATTHEW IAN
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:IAN
Last Name:KESSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:IAN
Other - Last Name:KESSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:86-04 GRAND AVE
Mailing Address - Street 2:SUITE L2
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:718-335-4980
Mailing Address - Fax:
Practice Address - Street 1:8604 GRAND AVE
Practice Address - Street 2:SUITE L2
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4366
Practice Address - Country:US
Practice Address - Phone:718-335-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice