Provider Demographics
NPI:1508884396
Name:STEVENS, KASAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KASAN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KASAN
Other - Middle Name:
Other - Last Name:STEVENS-HANSBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11918 SUNRAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5316
Mailing Address - Country:US
Mailing Address - Phone:225-291-2111
Mailing Address - Fax:225-291-2191
Practice Address - Street 1:11918 SUNRAY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5316
Practice Address - Country:US
Practice Address - Phone:225-291-2111
Practice Address - Fax:225-291-2191
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1853721Medicaid