Provider Demographics
NPI:1710030382
Name:KASU, SURAIYA A (BDS)
Entity Type:Individual
Prefix:DR
First Name:SURAIYA
Middle Name:A
Last Name:KASU
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W OAK ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6614
Mailing Address - Country:US
Mailing Address - Phone:407-846-2494
Mailing Address - Fax:407-846-2895
Practice Address - Street 1:801 W OAK ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6614
Practice Address - Country:US
Practice Address - Phone:407-846-2494
Practice Address - Fax:407-846-2895
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN93761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice