Provider Demographics
NPI:1265597850
Name:KASEM, MOHAMMAD ABUL (B D S)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ABUL
Last Name:KASEM
Suffix:
Gender:M
Credentials:B D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2142
Mailing Address - Country:US
Mailing Address - Phone:407-656-4702
Mailing Address - Fax:407-656-6006
Practice Address - Street 1:242 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2142
Practice Address - Country:US
Practice Address - Phone:407-656-4702
Practice Address - Fax:407-656-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 87441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice