Provider Demographics
NPI:1821420910
Name:KASSAM, ALIYA BADRUDIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALIYA
Middle Name:BADRUDIN
Last Name:KASSAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 RHODE ISLAND AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6815
Mailing Address - Country:US
Mailing Address - Phone:202-529-6468
Mailing Address - Fax:
Practice Address - Street 1:329 RHODE ISLAND AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6815
Practice Address - Country:US
Practice Address - Phone:202-529-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist