Provider Demographics
NPI:1578617114
Name:KASSABIAN, KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:KASSABIAN
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 1:6507 JESTER BLVD
Mailing Address - Street 2:#303
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8368
Mailing Address - Country:US
Mailing Address - Phone:512-418-9150
Mailing Address - Fax:512-418-9407
Practice Address - Street 1:6507 JESTER BLVD
Practice Address - Street 2:#303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8368
Practice Address - Country:US
Practice Address - Phone:512-418-9150
Practice Address - Fax:512-418-9407
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice