Provider Demographics
NPI:1710613484
Name:KALSI, ASISAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASISAN
Middle Name:
Last Name:KALSI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 S QUILLAN PL STE 110
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1899
Mailing Address - Country:US
Mailing Address - Phone:509-585-5437
Mailing Address - Fax:509-545-5438
Practice Address - Street 1:216 N EDISON ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1956
Practice Address - Country:US
Practice Address - Phone:509-737-0327
Practice Address - Fax:509-737-1360
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61319641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist