Provider Demographics
NPI:1497410799
Name:RAEDA A. KASSAR DENTAL CORPORATION
Entity Type:Organization
Organization Name:RAEDA A. KASSAR DENTAL CORPORATION
Other - Org Name:WOODGLEN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAEDA
Authorized Official - Middle Name:ADIB
Authorized Official - Last Name:KASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-914-4054
Mailing Address - Street 1:220 S. GLENDORA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741
Mailing Address - Country:US
Mailing Address - Phone:626-914-4054
Mailing Address - Fax:626-914-2377
Practice Address - Street 1:220 S. GLENDORA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741
Practice Address - Country:US
Practice Address - Phone:626-914-4054
Practice Address - Fax:626-914-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty