Provider Demographics
NPI:1760496780
Name:KASPER, EDWARD L (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:KASPER
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HILLGROVE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1442
Mailing Address - Country:US
Mailing Address - Phone:708-784-9930
Mailing Address - Fax:
Practice Address - Street 1:518 HILLGROVE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1442
Practice Address - Country:US
Practice Address - Phone:708-784-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-0253511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics