Provider Demographics
NPI:1174062855
Name:KATHLEEN A KASPER DDS PA
Entity type:Organization
Organization Name:KATHLEEN A KASPER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-446-0101
Mailing Address - Street 1:1514 E BELT LINE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6369
Mailing Address - Country:US
Mailing Address - Phone:972-446-0101
Mailing Address - Fax:972-446-0052
Practice Address - Street 1:1514 E BELT LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6369
Practice Address - Country:US
Practice Address - Phone:972-446-0101
Practice Address - Fax:972-446-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD16150332BC3200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty