Provider Demographics
NPI:1962240127
Name:KASEM DENTAL LLC
Entity type:Organization
Organization Name:KASEM DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NUSRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KASEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-443-4879
Mailing Address - Street 1:965 SADIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-0027
Mailing Address - Country:US
Mailing Address - Phone:850-443-4879
Mailing Address - Fax:
Practice Address - Street 1:2560 E HWY 50 STE 103
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8411
Practice Address - Country:US
Practice Address - Phone:352-989-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty