Provider Demographics
NPI:1376914200
Name:KASO, ELONA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELONA
Middle Name:
Last Name:KASO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 54TH ST
Mailing Address - Street 2:FL2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3011
Mailing Address - Country:US
Mailing Address - Phone:347-768-9298
Mailing Address - Fax:
Practice Address - Street 1:101 CRAWFORDS CORNER RD STE 1110
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1977
Practice Address - Country:US
Practice Address - Phone:732-444-8822
Practice Address - Fax:732-314-0222
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02619100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist