Provider Demographics
NPI:1497181739
Name:KASEM, SHOVON SAYFALDIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHOVON
Middle Name:SAYFALDIN
Last Name:KASEM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 PLANTATION KEY CIR
Mailing Address - Street 2:APT 102
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4656
Mailing Address - Country:US
Mailing Address - Phone:352-359-3371
Mailing Address - Fax:
Practice Address - Street 1:680 E STATE ROAD 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3184
Practice Address - Country:US
Practice Address - Phone:352-241-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist