Provider Demographics
NPI:1437458338
Name:KAWAS, ISSA (DDS)
Entity Type:Individual
Prefix:
First Name:ISSA
Middle Name:
Last Name:KAWAS
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 1:8690 SIERRA COLLEGE BLVD STE 160-171
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2190 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6453
Practice Address - Country:US
Practice Address - Phone:916-984-0304
Practice Address - Fax:916-983-9012
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611441223D0004X, 1223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery