Provider Demographics
NPI:1619535168
Name:QASIM, ASSAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASSAD
Middle Name:
Last Name:QASIM
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 1:2201 HUMES RD STE 150
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0742
Mailing Address - Country:US
Mailing Address - Phone:608-563-5565
Mailing Address - Fax:
Practice Address - Street 1:2201 HUMES RD STE 150
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0742
Practice Address - Country:US
Practice Address - Phone:608-563-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist