1942240221 NPI number — SIMON E KASWAN DDS

Table of content: SIMON E KASWAN DDS (NPI 1942240221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942240221 NPI number — SIMON E KASWAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASWAN
Provider First Name:
SIMON
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942240221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1021 IVES DAIRY RD, BLDG 3
Provider Second Line Business Mailing Address:
SUITE # 121
Provider Business Mailing Address City Name:
NORTH MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-651-7760
Provider Business Mailing Address Fax Number:
305-690-9963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 IVES DAIRY RD
Provider Second Line Business Practice Location Address:
BLDG 3, SUITE # 121
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33179-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-651-7760
Provider Business Practice Location Address Fax Number:
305-690-9963
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DN16371 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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