Provider Demographics
NPI:1376167155
Name:KASSAR, YOUSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUSEPH
Middle Name:
Last Name:KASSAR
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 1:680 POPLAR WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1109
Mailing Address - Country:US
Mailing Address - Phone:304-685-7905
Mailing Address - Fax:
Practice Address - Street 1:453 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3408
Practice Address - Country:US
Practice Address - Phone:304-598-5108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4462OtherDENTAL LICENSE