Provider Demographics
NPI:1851510853
Name:GASSER DENTAL
Entity Type:Organization
Organization Name:GASSER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GASSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-972-8217
Mailing Address - Street 1:17220 N BOSWELL BLVD
Mailing Address - Street 2:200
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-2000
Mailing Address - Country:US
Mailing Address - Phone:623-972-8217
Mailing Address - Fax:623-972-1406
Practice Address - Street 1:17220 N BOSWELL BLVD
Practice Address - Street 2:200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-2000
Practice Address - Country:US
Practice Address - Phone:623-972-8217
Practice Address - Fax:623-972-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2014-12-03
Deactivation Date:2013-02-19
Deactivation Code:
Reactivation Date:2013-06-12
Provider Licenses
StateLicense IDTaxonomies
AZD2478261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental