Provider Demographics
NPI:1942240221
Name:KASWAN, SIMON E (DDS)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:E
Last Name:KASWAN
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 1:1021 IVES DAIRY RD, BLDG 3
Mailing Address - Street 2:SUITE # 121
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179
Mailing Address - Country:US
Mailing Address - Phone:305-651-7760
Mailing Address - Fax:305-690-9963
Practice Address - Street 1:1021 IVES DAIRY RD
Practice Address - Street 2:BLDG 3, SUITE # 121
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-2537
Practice Address - Country:US
Practice Address - Phone:305-651-7760
Practice Address - Fax:305-690-9963
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice