Provider Demographics
NPI:1780958355
Name:DR. SURAIYA A.KASU BDS PA
Entity type:Organization
Organization Name:DR. SURAIYA A.KASU BDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURAIYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASU
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:407-846-2494
Mailing Address - Street 1:801 W OAK ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6605
Mailing Address - Country:US
Mailing Address - Phone:407-846-2494
Mailing Address - Fax:407-846-2895
Practice Address - Street 1:801 W OAK ST STE 102
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6605
Practice Address - Country:US
Practice Address - Phone:407-846-2494
Practice Address - Fax:407-846-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL077289500Medicaid