Provider Demographics
NPI:1184792236
Name:KASSUBE, THOMAS L (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:KASSUBE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-0537
Mailing Address - Country:US
Mailing Address - Phone:605-335-8830
Mailing Address - Fax:605-335-0947
Practice Address - Street 1:3805 S KIWANIS CIR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4266
Practice Address - Country:US
Practice Address - Phone:605-335-8830
Practice Address - Fax:605-335-0947
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM5521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDM552OtherLICENSE NUMBER
SDAK1045966OtherDEA NUMBER