Provider Demographics
NPI:1831261353
Name:DATTA, KESANG (DDS)
Entity type:Individual
Prefix:DR
First Name:KESANG
Middle Name:
Last Name:DATTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CROOKED STICK LN
Mailing Address - Street 2:
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-9529
Mailing Address - Country:US
Mailing Address - Phone:917-374-7390
Mailing Address - Fax:908-387-8322
Practice Address - Street 1:98 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6266
Practice Address - Country:US
Practice Address - Phone:570-599-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0220481223P0221X
PADS0428501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry