Provider Demographics
NPI:1023583051
Name:SAMEH M KASSEM DDS PC
Entity type:Organization
Organization Name:SAMEH M KASSEM DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-729-7447
Mailing Address - Street 1:19490 SANDRIDGE WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3470
Mailing Address - Country:US
Mailing Address - Phone:703-729-7447
Mailing Address - Fax:703-858-0448
Practice Address - Street 1:19490 SANDRIDGE WAY STE 110
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-3470
Practice Address - Country:US
Practice Address - Phone:703-729-7447
Practice Address - Fax:703-858-0448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMEH KASSEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-05
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid
VI=========Medicaid