Provider Demographics
NPI:1053711036
Name:ENDODONTIC ASSOCIATES OF TAMPA PA
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF TAMPA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAED
Authorized Official - Middle Name:S
Authorized Official - Last Name:AL KASEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:727-796-2183
Mailing Address - Street 1:3165 N MCMULLEN BOOTH RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2032
Mailing Address - Country:US
Mailing Address - Phone:727-796-2183
Mailing Address - Fax:727-726-8827
Practice Address - Street 1:11940 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3643
Practice Address - Country:US
Practice Address - Phone:727-796-2183
Practice Address - Fax:727-726-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty