Provider Demographics
NPI:1528193133
Name:KASSEM, SAMEH M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:M
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 1:19490 SANDRIDGE WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3465
Mailing Address - Country:US
Mailing Address - Phone:703-729-7447
Mailing Address - Fax:703-858-0448
Practice Address - Street 1:19490 SANDRIDGE WAY STE 110
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3465
Practice Address - Country:US
Practice Address - Phone:703-729-7447
Practice Address - Fax:703-858-0448
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA77911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice