Provider Demographics
NPI:1851752166
Name:KASSABJI, AHMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:KASSABJI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 EDNA CT APT 5402
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5868
Mailing Address - Country:US
Mailing Address - Phone:315-560-1988
Mailing Address - Fax:
Practice Address - Street 1:2101 N URSULA ST
Practice Address - Street 2:APT# 222
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7419
Practice Address - Country:US
Practice Address - Phone:315-560-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37192122300000X, 1223E0200X
CO002027621223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice