Provider Demographics
NPI:1740365592
Name:KASSMAN, ANDREW LANCE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:LANCE
Last Name:KASSMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6700 N. ORACLE ROAD
Mailing Address - Street 2:SUITE 327
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7740
Mailing Address - Country:US
Mailing Address - Phone:520-575-1177
Mailing Address - Fax:520-297-3328
Practice Address - Street 1:6700 N. ORACLE ROAD
Practice Address - Street 2:SUITE 327
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7740
Practice Address - Country:US
Practice Address - Phone:520-575-1177
Practice Address - Fax:520-297-3328
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ601947OtherUNITED CONCORDIA-TRICARE