Provider Demographics
NPI:1457084246
Name:KASSEM, TAREK MOHSEN (DDS)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:MOHSEN
Last Name:KASSEM
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 1:1754 EUCLID ST APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4329
Mailing Address - Country:US
Mailing Address - Phone:310-804-6197
Mailing Address - Fax:
Practice Address - Street 1:UCLA CHILDREN'S DENTAL CENTER
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-5619
Practice Address - Fax:310-825-8728
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist